Organization
GREAT SOUTHWEST FAMILY DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRIS HUNG TRUONG DDS (BUSINESS OWNER)
(972) 660-8457
Entity
Organization
Contact information
Practice address
2308 BARDIN RD STE 100, GRAND PRAIRIE, TX 75052-3857
(972) 660-8457
(469) 660-0100
Mailing address
2308 BARDIN RD STE 100, GRAND PRAIRIE, TX 75052-3857
(972) 660-8457
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142310512
—
TX
Enumeration date
08/09/2019
Last updated
08/09/2019
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