Provider Demographics
NPI:1710413901
Name:NGUYEN, DUC TRUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUC TRUNG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5506
Mailing Address - Country:US
Mailing Address - Phone:770-380-0825
Mailing Address - Fax:
Practice Address - Street 1:55 FREEDOM PKWY STE 104
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-1996
Practice Address - Country:US
Practice Address - Phone:706-658-2383
Practice Address - Fax:706-658-2396
Is Sole Proprietor?:No
Enumeration Date:2017-05-07
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist