Provider Demographics
NPI:1629400130
Name:TRUONG, VANNA THI (DMD)
Entity type:Individual
Prefix:DR
First Name:VANNA
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:VANANH
Other - Middle Name:THI
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:526 S TONOPAH DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4043
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:3040 W ANN RD
Practice Address - Street 2:STE. 101
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-7265
Practice Address - Country:US
Practice Address - Phone:702-839-2244
Practice Address - Fax:702-839-1415
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1629400130Medicaid