Healthcare Provider Details

I. General information

NPI: 1184368722
Provider Name (Legal Business Name): THANH HUU TRUONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12444 NW 10TH ST STE 107
YUKON OK
73099-5844
US

IV. Provider business mailing address

4110 W KENT CT
BROKEN ARROW OK
74012-9488
US

V. Phone/Fax

Practice location:
  • Phone: 405-708-7702
  • Fax:
Mailing address:
  • Phone: 918-428-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7593
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: