Provider Demographics
NPI:1023204401
Name:MUN TRAN, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MUN TRAN, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:STANTON DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUN
Authorized Official - Middle Name:NGA
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-651-5521
Mailing Address - Street 1:10342 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-1607
Mailing Address - Country:US
Mailing Address - Phone:714-484-1217
Mailing Address - Fax:
Practice Address - Street 1:10342 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-1607
Practice Address - Country:US
Practice Address - Phone:714-484-1217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93439-01Medicaid