Provider Demographics
NPI:1801055603
Name:TRUONG, THANH HUONG THI (DDS)
Entity type:Individual
Prefix:DR
First Name:THANH HUONG
Middle Name:THI
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 1:6201 LEESBURG PIKE
Mailing Address - Street 2:STE # 401
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2201
Mailing Address - Country:US
Mailing Address - Phone:703-533-3960
Mailing Address - Fax:703-533-3889
Practice Address - Street 1:6201 LEESBURG PIKE
Practice Address - Street 2:STE # 401
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2201
Practice Address - Country:US
Practice Address - Phone:703-533-3960
Practice Address - Fax:703-533-3889
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014103161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA15902Medicaid