Organization
ISMILE DENTAL AT LA GRAN PLAZA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THANH TRUONG DDS (PRESIDENT)
(817) 924-8000
Entity
Organization
Contact information
Practice address
4200 SOUTH FWY, SUITE 1550, FORT WORTH, TX 76115-1400
(817) 924-8000
Mailing address
PO BOX 16249, FORT WORTH, TX 76162-0249
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22611
TX
Other
Enumeration date
09/27/2012
Last updated
09/27/2012
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