Provider Demographics
NPI:1740056944
Name:ETHAN TRUONG DDS OF HOUSTON PLLC
Entity type:Organization
Organization Name:ETHAN TRUONG DDS OF HOUSTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-200-6508
Mailing Address - Street 1:1750 E LEAGUE CITY PKWY APT 234
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2692
Mailing Address - Country:US
Mailing Address - Phone:678-200-6508
Mailing Address - Fax:
Practice Address - Street 1:7995 BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-1960
Practice Address - Country:US
Practice Address - Phone:713-641-6247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty