Provider Demographics
NPI:1255511358
Name:TRAC, TRINH PHUONG (DDS)
Entity type:Individual
Prefix:
First Name:TRINH
Middle Name:PHUONG
Last Name:TRAC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33448 ALVARADO NILES RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3110
Mailing Address - Country:US
Mailing Address - Phone:510-429-1178
Mailing Address - Fax:510-429-1151
Practice Address - Street 1:33448 ALVARADO NILES RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3110
Practice Address - Country:US
Practice Address - Phone:510-429-1178
Practice Address - Fax:510-429-1151
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54033122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice