MEDICARE: TIFFANY TRUONG D.D.S.

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	46538	CA

General Provider Information

NPI Number	:	1841201506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY TRUONG D.D.S.

Provider Business Mailing Address
First Line	:	1303 W 6TH ST
Second Line	:	STE 103
City	:	CORONA
State	:	CA
Zip	:	92882-3196
Country	:	US
Telephone Number	:	951-898-2101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 W 6TH ST
Second Line	:	STE 103
City	:	CORONA
State	:	CA
Zip	:	92882-3196
Country	:	US
Telephone Number	:	951-898-2101
Fax Number	:

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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