Provider Demographics
NPI:1710967641
Name:O'LEARY, TRUYEN THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRUYEN
Middle Name:THI
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TRUYEN
Other - Middle Name:THI
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:BLDG 9900, 2ND FLOOR
Mailing Address - Street 2:U.S. ARMY DENTAL ACTIVITY - FT LEWIS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4039
Mailing Address - Fax:253-968-5919
Practice Address - Street 1:BLDG 9900, 2ND FLOOR
Practice Address - Street 2:U.S. ARMY DENTAL ACTIVITY - FT LEWIS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-4039
Practice Address - Fax:253-968-5919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000098471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice