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General NPI Number Information
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NPI Number | 1609096064
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Entity Type | Organization
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Legal Business Name | ISMILE DENTAL
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 5824 SOUTH HULEN ST.
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City | FORT WORTH
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State | TX
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Zip | 76132
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Country | US
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Telephone | 817-292-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 5824 SOUTH HULEN ST.
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City | FORT WORTH
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State | TX
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Zip | 76132
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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 | PRESIDENT
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Name | DR. THANH NGOC TRUONG
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Credential | D.D.S
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Telephone | 817-292-9500
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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 | 22611
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License Number State | TX
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