1669698585 NPI number — DUC HUU TRUONG DMD

Table of content: DUC HUU TRUONG DMD (NPI 1669698585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669698585 NPI number — DUC HUU TRUONG DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUONG
Provider First Name:
DUC
Provider Middle Name:
HUU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669698585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58 EAST BORDER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-325-5353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1775 WASHINGTON ST
Provider Second Line Business Practice Location Address:
UNIDENT DENTAL CENTER
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-826-8866
Provider Business Practice Location Address Fax Number:
780-826-1474
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  18611 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0280259 . This is a "MASS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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