Healthcare Provider Details

I. General information

NPI: 1710496013
Provider Name (Legal Business Name): CHI DIEU TRUONG RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 UNIVERSITY BLVD STE 101
ORLANDO FL
32817-2196
US

IV. Provider business mailing address

11500 UNIVERSITY BLVD STE 101
ORLANDO FL
32817-2196
US

V. Phone/Fax

Practice location:
  • Phone: 407-737-6464
  • Fax:
Mailing address:
  • Phone: 253-967-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number16230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: