Individual provider Active NPI

Ethan Truong, DDS

  • Dentist
  • Galveston, TX
National Provider Identifier
1801270376
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
33975 Issued in TX
Practice address
1801 Broadway St
Galveston, TX 77550-4912
Phone
(409) 762-8443
NPI assigned
Jul 15, 2015
Last updated
Sep 11, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4066 AR
Dentist 122300000X 33975 TX Primary

Addresses

Primary practice location

1801 Broadway St
Galveston, TX 77550-4912

Mailing address

3433 Cove View Blvd Apt 3517
Galveston, TX 77554-8188
Phone (678) 200-6508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4066ARMDDentist
33975TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Ethan Truong DDS of League City PLLC CurrentSince Aug 29, 2021 Accepting new patients
Ethan Truong DDS of Houston PLLC CurrentSince Dec 3, 2023 Accepting new patients
Ethan Truong, DDS PLLC CurrentSince Sep 20, 2020 Accepting new patients
J Thomas Carroll DDS PC PastSince Sep 13, 2020 Accepting new patients

Locations

1801 Broadway St
Galveston, TX 77550
Phone (409) 762-8443

7995 Bellfort St
Houston, TX 77061
Phone (713) 641-6247

1901 E Main St
League City, TX 77573
Phone (281) 332-6323

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1801270376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3433 COVE VIEW BLVD APT 3517",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775548188",
            "telephone_number": "678-200-6508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 BROADWAY ST",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775504912",
            "telephone_number": "409-762-8443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRUONG",
        "first_name": "ETHAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-15",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "4066",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "33975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galveston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.