Provider Demographics
NPI:1134614878
Name:TRUONG, DUY V (DMD)
Entity type:Individual
Prefix:DR
First Name:DUY
Middle Name:V
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6898 A C SKINNER PKWY UNIT 348
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7930
Mailing Address - Country:US
Mailing Address - Phone:954-608-7884
Mailing Address - Fax:
Practice Address - Street 1:4520 TOWN CENTER PKWY UNIT 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8590
Practice Address - Country:US
Practice Address - Phone:904-717-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN233931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice