Provider Demographics
NPI:1801008495
Name:TRINH, MATT-PHUOC QUY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATT-PHUOC
Middle Name:QUY
Last Name:TRINH
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 1:17480 ARROW BLVD
Mailing Address - Street 2:STE 10
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-9108
Mailing Address - Country:US
Mailing Address - Phone:909-822-4777
Mailing Address - Fax:909-822-2926
Practice Address - Street 1:17480 ARROW BLVD
Practice Address - Street 2:STE 10
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-9108
Practice Address - Country:US
Practice Address - Phone:909-822-4777
Practice Address - Fax:909-822-2926
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice