Healthcare Provider Details

I. General information

NPI: 1538868153
Provider Name (Legal Business Name): DR. CHAD VU TRUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 OPPORTUNITY BLVD S STE A
CAMBRIDGE MN
55008-2222
US

IV. Provider business mailing address

240 PARK AVE UNIT 508
MINNEAPOLIS MN
55415-2254
US

V. Phone/Fax

Practice location:
  • Phone: 763-310-1206
  • Fax:
Mailing address:
  • Phone: 214-669-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15497
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: