Provider Demographics
NPI:1720973316
Name:TRUONG, LINH (DDS , MMS)
Entity type:Individual
Prefix:
First Name:LINH
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DDS , MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 BOLTON SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-4756
Mailing Address - Country:US
Mailing Address - Phone:239-357-6247
Mailing Address - Fax:
Practice Address - Street 1:3269 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3823
Practice Address - Country:US
Practice Address - Phone:317-830-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014773A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist