MEDICARE: DR. VANNA THI TRUONG D.M.D

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	122300000X	Dentist	6436	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629400130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANNA THI TRUONG D.M.D

Provider Business Mailing Address
First Line	:	526 S TONOPAH DR
Second Line	:	STE. 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4043
Country	:	US
Telephone Number	:	702-291-2031
Fax Number	:	702-366-1483

Provider Business Practice Location Address
First Line	:	3040 W ANN RD
Second Line	:	STE. 101
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7265
Country	:	US
Telephone Number	:	702-839-2244
Fax Number	:	702-839-1415

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/23/2016

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