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General NPI Number Information
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NPI Number | 1063433654
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Entity Type | Individual
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Provider Name | KELLY M TRUONG DDS
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 55 CROSSPOINT PARKWAY SUITE 130
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City | GETZVILLE
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State | NY
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Zip | 14068-1615
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Country | US
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Telephone | 716-639-5900
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Fax | 716-639-5901
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Provider Business Mailing Address
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Address Line | 55 CROSSPOINT PARKWAY SUITE 130
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City | GETZVILLE
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State | NY
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Zip | 14068-1615
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Country | US
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Telephone | 716-639-5900
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Fax | 716-639-5901
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 051944
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License Number State | NY
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