Provider Demographics
NPI:1679799373
Name:TRUONG, DALENA TRANG (DMD)
Entity type:Individual
Prefix:DR
First Name:DALENA
Middle Name:TRANG
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TRANG
Other - Middle Name:THANH
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2673 SCOTTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2504
Mailing Address - Country:US
Mailing Address - Phone:408-528-8783
Mailing Address - Fax:408-528-8783
Practice Address - Street 1:1657 MCKEE RD
Practice Address - Street 2:SUITE 40
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1209
Practice Address - Country:US
Practice Address - Phone:408-937-9229
Practice Address - Fax:408-937-6169
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice