Provider Demographics
NPI:1710496013
Name:TRUONG, CHI DIEU (RDH)
Entity Type:Individual
Prefix:MS
First Name:CHI
Middle Name:DIEU
Last Name:TRUONG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 UNIVERSITY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2196
Mailing Address - Country:US
Mailing Address - Phone:253-967-5271
Mailing Address - Fax:
Practice Address - Street 1:11500 UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2196
Practice Address - Country:US
Practice Address - Phone:407-737-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16230124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist