Healthcare Provider Details

I. General information

NPI: 1851220636
Provider Name (Legal Business Name): PHUONG T DUONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14640 VILLAGE MARKET ST STE 103
BATON ROUGE LA
70817-7696
US

IV. Provider business mailing address

4025 W NAPOLEON AVE APT 218
METAIRIE LA
70001-2573
US

V. Phone/Fax

Practice location:
  • Phone: 225-407-4429
  • Fax:
Mailing address:
  • Phone: 225-324-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7784
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: