Provider Demographics
NPI:1740485184
Name:TRUONG, MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:TRUONG
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 1:11416 FM 620 N
Mailing Address - Street 2:SUITE K
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1161
Mailing Address - Country:US
Mailing Address - Phone:512-382-7123
Mailing Address - Fax:512-432-5506
Practice Address - Street 1:11416 FM 620 N
Practice Address - Street 2:SUITE K
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-1161
Practice Address - Country:US
Practice Address - Phone:512-382-7123
Practice Address - Fax:512-432-5506
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice