Provider Demographics
NPI:1720413735
Name:TRUONG, RICHARD TRI QUAN (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TRI QUAN
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1944
Mailing Address - Country:US
Mailing Address - Phone:510-388-0616
Mailing Address - Fax:
Practice Address - Street 1:1941 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2525
Practice Address - Country:US
Practice Address - Phone:925-689-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA627201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice