Healthcare Provider Details

I. General information

NPI: 1144168899
Provider Name (Legal Business Name): ANDREW TRUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 OIL HILL RD
EL DORADO KS
67042-3352
US

IV. Provider business mailing address

310 OIL HILL RD
EL DORADO KS
67042-3352
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-4222
  • Fax:
Mailing address:
  • Phone: 316-321-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62429
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: