Provider Demographics
NPI:1932474186
Name:TRUONG, THU THANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:THU
Middle Name:THANH
Last Name:TRUONG
Suffix:
Gender:M
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:P.O. BOX 45
Mailing Address - Street 2:412 HALE AVENUE
Mailing Address - City:NEWMAN GROVE
Mailing Address - State:NE
Mailing Address - Zip Code:68758-0045
Mailing Address - Country:US
Mailing Address - Phone:402-447-6469
Mailing Address - Fax:402-447-6098
Practice Address - Street 1:412 HALE AVENUE
Practice Address - Street 2:
Practice Address - City:NEWMAN GROVE
Practice Address - State:NE
Practice Address - Zip Code:68758-0045
Practice Address - Country:US
Practice Address - Phone:402-447-6469
Practice Address - Fax:402-447-6098
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5593122300000X
SDM900122300000X
CA37614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE68-0521566-01Medicaid
NE68-0521566-00Medicaid