MEDICARE: KAREN THU TRUONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	35384	TX

General Provider Information

NPI Number	:	1427619162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN THU TRUONG DDS

Provider Business Mailing Address
First Line	:	24442 US HIGHWAY 281 N APT 1024
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-7233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23522 WILDERNESS OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2408
Country	:	US
Telephone Number	:	210-591-0109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/24/2019

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