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General NPI Number Information
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NPI Number | 1386203230
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Entity Type | Organization
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Legal Business Name | LE-TRUONG DENTAL 1, INC.
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 15580 US HIGHWAY 36
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City | MARYSVILLE
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State | OH
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Zip | 43040-9415
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Country | US
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Telephone | 801-703-0399
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Fax |
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Provider Business Mailing Address
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Address Line | 3375 RESORT CT
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City | POWELL
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State | OH
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Zip | 43065-9260
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | HUNG KHANH TRUONG
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Credential | DDS
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Telephone | 801-703-0399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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