Provider Demographics
NPI:1982387577
Name:TRUONG, ALAN CHANH (DMD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:CHANH
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 W MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1331
Mailing Address - Country:US
Mailing Address - Phone:408-599-8180
Mailing Address - Fax:
Practice Address - Street 1:9515 W CAMELBACK RD STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1365
Practice Address - Country:US
Practice Address - Phone:623-877-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist