Healthcare Provider Details

I. General information

NPI: 1891135653
Provider Name (Legal Business Name): JOSEPH K DUONG DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 W. THOMAS RD. BUILDING 2, SUITE 114
PHOENIX AZ
85037
US

IV. Provider business mailing address

8410 W. THOMAS RD. BUILDING 2, SUITE 114
PHOENIX AZ
85037
US

V. Phone/Fax

Practice location:
  • Phone: 623-247-5800
  • Fax: 623-247-5808
Mailing address:
  • Phone: 623-247-5800
  • Fax: 623-247-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6706
License Number StateAZ

VIII. Authorized Official

Name: DR. JOSEPH K DUONG
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 702-686-3308