MEDICARE: DUONG FAMILY DENTISTRY, PC

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	55638	OK

General Provider Information

NPI Number	:	1538289178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUONG FAMILY DENTISTRY, PC

Provider Business Mailing Address
First Line	:	2836 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2214
Country	:	US
Telephone Number	:	405-943-9010
Fax Number	:	405-943-9280

Provider Business Practice Location Address
First Line	:	2836 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2214
Country	:	US
Telephone Number	:	405-943-9010
Fax Number	:	405-943-9280

Authorized Official
Title or Position	:	DENTIST, OWNER
Name	:	DR. NHA TRUNG DUONG
Credential	:	D.D.S.
Telephone Number	:	405-943-9010

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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