Provider Demographics
NPI:1487981726
Name:TRUONG, KEVIN LONG (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LONG
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:LONG
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2603 W WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1582
Mailing Address - Country:US
Mailing Address - Phone:509-325-4227
Mailing Address - Fax:509-326-1043
Practice Address - Street 1:2603 W WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1582
Practice Address - Country:US
Practice Address - Phone:509-325-4227
Practice Address - Fax:509-326-1043
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60099000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist