Basic Information
| Provider Information | |||||||||
| NPI: | 1043886880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHUNG | ||||||||
| FirstName: | DELENA | ||||||||
| MiddleName: | HIEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2ND DENTAL BATTALION | ||||||||
| Address2: | PSC BOX 20130 | ||||||||
| City: | CAMP LEJEUNE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285420125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104511658 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2ND DENTAL BATTALION | ||||||||
| Address2: | |||||||||
| City: | CAMP LEJEUNE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285420125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104511658 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2021 | ||||||||
| LastUpdateDate: | 08/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 7210 | LA | N | Dental Providers | Dentist | 122300000X | 12384 | NC | N | Dental Providers | Dentist | 171000000X | Y | Other Service Providers | Military Health Care Provider |
No ID Information.