MEDICARE: KHIEM NGOC TRUONG D.M.D

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	1223P0221X	Pediatric Dentistry	DN015527	GA
2	122300000X	Dentist	DN015527	GA

General Provider Information

NPI Number	:	1508397704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHIEM NGOC TRUONG D.M.D

Provider Business Mailing Address
First Line	:	4013 WINDER HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3022
Country	:	US
Telephone Number	:	404-421-3086
Fax Number	:

Provider Business Practice Location Address
First Line	:	4013 WINDER HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3022
Country	:	US
Telephone Number	:	678-673-3243
Fax Number	:

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

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	09/04/2025

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