Provider Demographics
NPI:1184792681
Name:TRUONG, PETER (DMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
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 1:702 ALBANESE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1004
Mailing Address - Country:US
Mailing Address - Phone:408-293-6413
Mailing Address - Fax:
Practice Address - Street 1:1124 W OLIVE AVE STE 101
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1939
Practice Address - Country:US
Practice Address - Phone:209-383-2186
Practice Address - Fax:209-383-2188
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist