Provider Demographics
NPI:1245924356
Name:TRUONG, HUY RICHARD CONG (DDS)
Entity type:Individual
Prefix:DR
First Name:HUY RICHARD
Middle Name:CONG
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 1:2045 GULF TO BAY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3752
Mailing Address - Country:US
Mailing Address - Phone:727-474-0211
Mailing Address - Fax:
Practice Address - Street 1:2045 GULF TO BAY BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3752
Practice Address - Country:US
Practice Address - Phone:727-474-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist