Provider Demographics
NPI:1306234976
Name:MATT-PHUOC TRINH, DMD DDS, INC
Entity type:Organization
Organization Name:MATT-PHUOC TRINH, DMD DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT-PHUOC
Authorized Official - Middle Name:QUY
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-822-4777
Mailing Address - Street 1:17185 ARROW BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3972
Mailing Address - Country:US
Mailing Address - Phone:909-822-4777
Mailing Address - Fax:909-822-2926
Practice Address - Street 1:17185 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3972
Practice Address - Country:US
Practice Address - Phone:909-822-4777
Practice Address - Fax:909-822-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty