Provider Demographics
NPI:1366609869
Name:DUONG, TRUC QUANG (DDS)
Entity type:Individual
Prefix:
First Name:TRUC
Middle Name:QUANG
Last Name:DUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21145 WHITFIELD PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7282
Mailing Address - Country:US
Mailing Address - Phone:703-404-1115
Mailing Address - Fax:703-404-5600
Practice Address - Street 1:21145 WHITFIELD PL
Practice Address - Street 2:SUITE 103
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7282
Practice Address - Country:US
Practice Address - Phone:703-404-1115
Practice Address - Fax:703-404-5600
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014100391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice