Provider Demographics
NPI:1073042818
Name:TRAN, HUY (DMD)
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 N COCOA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOHN
Mailing Address - State:FL
Mailing Address - Zip Code:32927-5012
Mailing Address - Country:US
Mailing Address - Phone:321-631-2111
Mailing Address - Fax:
Practice Address - Street 1:6825 N COCOA BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-5012
Practice Address - Country:US
Practice Address - Phone:321-631-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN226551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice