# ISMILE DENTAL AT LA GRAN PLAZA, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629329891
- **Authorized official:** THANH TRUONG DDS (PRESIDENT)
- **Authorized official phone:** (817) 924-8000

## Contact information

- **Practice address:** 4200 SOUTH FWY, SUITE 1550, FORT WORTH, TX 76115-1400
- **Practice address phone:** (817) 924-8000
- **Mailing address:** PO BOX 16249, FORT WORTH, TX 76162-0249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22611 | TX | Yes |

## Other

- **Enumeration date:** 09/27/2012
- **Last updated:** 09/27/2012