MEDICARE: THANH HUONG TRUONG DDS, 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	VA0401610316	VA

General Provider Information

NPI Number	:	1639153653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THANH HUONG TRUONG DDS, PC.

Provider Business Mailing Address
First Line	:	6201 LEESBURG PIKE
Second Line	:	STE 401
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2201
Country	:	US
Telephone Number	:	703-533-3960
Fax Number	:	703-533-3889

Provider Business Practice Location Address
First Line	:	6201 LEESBURG PIKE
Second Line	:	STE 401
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2201
Country	:	US
Telephone Number	:	703-533-3960
Fax Number	:	703-533-3839

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THANH HUONG THI TRUONG
Credential	:	DDS
Telephone Number	:	703-533-3960

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	06/20/2008

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