Provider Demographics
NPI:1972986479
Name:TRUONG, VY HA (DMD)
Entity Type:Individual
Prefix:
First Name:VY
Middle Name:HA
Last Name:TRUONG
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 1:3706 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-5243
Mailing Address - Country:US
Mailing Address - Phone:904-777-1477
Mailing Address - Fax:904-777-3927
Practice Address - Street 1:3706 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-5243
Practice Address - Country:US
Practice Address - Phone:904-777-1477
Practice Address - Fax:904-777-3927
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist