Provider Demographics
NPI:1407423130
Name:NGUYEN, TRUC THUY (DMD)
Entity type:Individual
Prefix:
First Name:TRUC
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12831 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-2408
Mailing Address - Country:US
Mailing Address - Phone:727-403-9296
Mailing Address - Fax:
Practice Address - Street 1:225 S HURSTBOURNE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4929
Practice Address - Country:US
Practice Address - Phone:727-403-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11019122300000X
FL25875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist