Provider Demographics
NPI:1760167050
Name:THAI, ANN TRUONG (DMD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:TRUONG
Last Name:THAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ELDON DR
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-2756
Mailing Address - Country:US
Mailing Address - Phone:864-593-0900
Mailing Address - Fax:
Practice Address - Street 1:2708 CLEMSON RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8264
Practice Address - Country:US
Practice Address - Phone:803-830-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice