Organization
BANYAN TREE DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE TRUONG D.D.S. (PRESIDENT)
(512) 382-7123
Entity
Organization
Contact information
Practice address
11416 FM 620 STE N, SUITE K, AUSTIN, TX 78726-1165
(512) 382-7123
Mailing address
11416 FM 620 STE N, SUITE K, AUSTIN, TX 78726-1165
(512) 382-7123
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19143
TX
Other
Enumeration date
04/03/2013
Last updated
04/03/2013
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