Healthcare Provider Details

I. General information

NPI: 1982694055
Provider Name (Legal Business Name): JOSEPH DUONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 06/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 W THOMAS RD BUILDING 2, SUITE 114
PHOENIX AZ
85037-3329
US

IV. Provider business mailing address

8410 W THOMAS RD BUILDING 2, SUITE 114
PHOENIX AZ
85037-3329
US

V. Phone/Fax

Practice location:
  • Phone: 702-686-3308
  • Fax:
Mailing address:
  • Phone: 623-247-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD6706
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5526
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: