MEDICARE: TRUC QUANG DUONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401410039	VA

General Provider Information

NPI Number	:	1366609869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUC QUANG DUONG DDS

Provider Business Mailing Address
First Line	:	21145 WHITFIELD PL
Second Line	:	SUITE 103
City	:	STERLING
State	:	VA
Zip	:	20165-7282
Country	:	US
Telephone Number	:	703-404-1115
Fax Number	:	703-404-5600

Provider Business Practice Location Address
First Line	:	21145 WHITFIELD PL
Second Line	:	SUITE 103
City	:	STERLING
State	:	VA
Zip	:	20165-7282
Country	:	US
Telephone Number	:	703-404-1115
Fax Number	:	703-404-5600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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