Provider Demographics
NPI:1710980529
Name:TRUONG, SARA T (DDS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:T
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 SOUTH DR
Mailing Address - Street 2:STE C
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4208
Mailing Address - Country:US
Mailing Address - Phone:650-961-4766
Mailing Address - Fax:
Practice Address - Street 1:485 SOUTH DR
Practice Address - Street 2:STE C
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4208
Practice Address - Country:US
Practice Address - Phone:650-961-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-11-04
Deactivation Date:2005-05-24
Deactivation Code:
Reactivation Date:2014-11-04
Provider Licenses
StateLicense IDTaxonomies
CA46705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA001313570OtherUNITED CONCORDIA PROVIDER