Provider Demographics
NPI:1255592978
Name:TINA TRUONG D.M.D., PC.
Entity type:Organization
Organization Name:TINA TRUONG D.M.D., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-333-5105
Mailing Address - Street 1:4810 BEAUREGARD ST
Mailing Address - Street 2:200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1709
Mailing Address - Country:US
Mailing Address - Phone:703-333-5105
Mailing Address - Fax:703-333-5106
Practice Address - Street 1:4810 BEAUREGARD ST
Practice Address - Street 2:200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1709
Practice Address - Country:US
Practice Address - Phone:703-333-5105
Practice Address - Fax:703-333-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty