Provider Demographics
NPI:1043886880
Name:PHUNG, DELENA HIEN (DDS)
Entity type:Individual
Prefix:DR
First Name:DELENA
Middle Name:HIEN
Last Name:PHUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2ND DENTAL BATTALION
Mailing Address - Street 2:PSC BOX 20130
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0125
Mailing Address - Country:US
Mailing Address - Phone:910-451-1658
Mailing Address - Fax:
Practice Address - Street 1:2ND DENTAL BATTALION
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0125
Practice Address - Country:US
Practice Address - Phone:910-451-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7210122300000X
NC12384122300000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No122300000XDental ProvidersDentist