Provider Demographics
NPI:1073597837
Name:TRAN, LARRY (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W CLEVELAND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2908
Mailing Address - Country:US
Mailing Address - Phone:414-383-5500
Mailing Address - Fax:414-383-5400
Practice Address - Street 1:2727 W CLEVELAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2908
Practice Address - Country:US
Practice Address - Phone:414-383-5500
Practice Address - Fax:414-383-5400
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33741000Medicaid