MEDICARE: VICTOR TRUONG, DDS, DENTAL CORP

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	261QD0000X	Dental Clinic/Center	59878	CA

General Provider Information

NPI Number	:	1558814368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTOR TRUONG, DDS, DENTAL CORP

Provider Business Mailing Address
First Line	:	6200 CENTER ST
Second Line	:	SUITE I
City	:	CLAYTON
State	:	CA
Zip	:	94517-1446
Country	:	US
Telephone Number	:	925-330-5157
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 CENTER ST
Second Line	:	SUITE I
City	:	CLAYTON
State	:	CA
Zip	:	94517-1446
Country	:	US
Telephone Number	:	925-330-5157
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTOR DUC TRUONG
Credential	:	DDS
Telephone Number	:	925-330-5157

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	11/08/2016

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