Healthcare Provider Details

I. General information

NPI: 1942704499
Provider Name (Legal Business Name): NGOC TRANG CAROLINE TRUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DRIVEROOM D1-19
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

PO BOX 100415
GAINESVILLE FL
32610-0415
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN22013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: