Provider Demographics
NPI:1023339736
Name:NGUYEN & TRUONG DENTAL CORP
Entity type:Organization
Organization Name:NGUYEN & TRUONG DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-642-1536
Mailing Address - Street 1:12385 CENTRAL AVE
Mailing Address - Street 2:UNIT # A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2624
Mailing Address - Country:US
Mailing Address - Phone:909-628-4141
Mailing Address - Fax:909-628-4121
Practice Address - Street 1:12385 CENTRAL AVE
Practice Address - Street 2:UNIT # A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2624
Practice Address - Country:US
Practice Address - Phone:909-628-4141
Practice Address - Fax:909-628-4121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NGUYEN & TRUONG DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479681223G0001X
CA465381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty