Provider Demographics
NPI:1679543854
Name:TRUONG, THUY HOANG (DDS02)
Entity type:Individual
Prefix:
First Name:THUY
Middle Name:HOANG
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DDS02
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5871 FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3907
Mailing Address - Country:US
Mailing Address - Phone:281-487-7774
Mailing Address - Fax:
Practice Address - Street 1:5871 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3907
Practice Address - Country:US
Practice Address - Phone:281-487-7774
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21844OtherLICENSE