Provider Demographics
NPI:1922791946
Name:TRUONG, ALEX STEPHEN
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:STEPHEN
Last Name:TRUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 STATIONHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1200
Mailing Address - Country:US
Mailing Address - Phone:571-533-6850
Mailing Address - Fax:
Practice Address - Street 1:616 CAMPUS DR STE 100
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9706
Practice Address - Country:US
Practice Address - Phone:276-525-4487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist