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General NPI Number Information
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NPI Number | 1902535743
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Entity Type | Individual
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Provider Name | JORDAN TRUONG DMD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 4325 AIRLINE DR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-3923
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Country | US
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Telephone | 318-742-9333
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Fax | 318-747-9089
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Provider Business Mailing Address
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Address Line | 6419 N VANDIVER RD APT 2110
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City | SAN ANTONIO
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State | TX
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Zip | 78209-4483
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Country | US
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Telephone | 650-773-6408
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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 |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7580
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License Number State | LA
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