Provider Demographics
NPI:1841395217
Name:TRUONG, PHUONGTU THI (DDS)
Entity Type:Individual
Prefix:
First Name:PHUONGTU
Middle Name:THI
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 1:7837 GARVEY AVE
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770
Mailing Address - Country:US
Mailing Address - Phone:626-288-2045
Mailing Address - Fax:626-288-4739
Practice Address - Street 1:7837 GARVEY AVE
Practice Address - Street 2:SUITE 102B
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770
Practice Address - Country:US
Practice Address - Phone:626-288-2045
Practice Address - Fax:626-288-4739
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice