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General NPI Number Information
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NPI Number | 1184368722
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Entity Type | Individual
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Provider Name | THANH HUU TRUONG DDS
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Gender | Male
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 12444 NW 10TH ST STE 107
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City | YUKON
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State | OK
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Zip | 73099-5844
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Country | US
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Telephone | 405-708-7702
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Fax |
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Provider Business Mailing Address
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Address Line | 4110 W KENT CT
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City | BROKEN ARROW
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State | OK
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Zip | 74012-9488
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Country | US
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Telephone | 918-428-8961
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7593
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License Number State | OK
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