Healthcare Provider Details

I. General information

NPI: 1912764176
Provider Name (Legal Business Name): KRISTI TRUONG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 PARNELL AVE
FORT WAYNE IN
46805-1413
US

IV. Provider business mailing address

10319 POKAGON LOOP
FORT WAYNE IN
46818-0193
US

V. Phone/Fax

Practice location:
  • Phone: 260-297-7511
  • Fax:
Mailing address:
  • Phone: 609-947-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014959A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7859
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: