Provider Demographics
NPI:1518701242
Name:TRUONG, BRANDON XUAN BAO (DDS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:XUAN BAO
Last Name:TRUONG
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 1:1005 11TH ST APT 1434
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6982
Mailing Address - Country:US
Mailing Address - Phone:662-394-5171
Mailing Address - Fax:
Practice Address - Street 1:2221 W LEDBETTER DR STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4746
Practice Address - Country:US
Practice Address - Phone:214-234-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice