Provider Demographics
NPI:1740701861
Name:HOANG TRUONG DDS INC
Entity type:Organization
Organization Name:HOANG TRUONG DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOANG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-649-0249
Mailing Address - Street 1:2550 W EL CAMINO AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3900
Mailing Address - Country:US
Mailing Address - Phone:916-649-0249
Mailing Address - Fax:916-649-0258
Practice Address - Street 1:576 N SUNRISE AVE STE 130
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2846
Practice Address - Country:US
Practice Address - Phone:916-784-3337
Practice Address - Fax:916-784-7459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOANG TRUONG DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54687261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental