Provider Demographics
NPI:1164784260
Name:TRAN, STEPHANIE ANH-THU (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANH-THU
Last Name:TRAN
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 1:26 WHITE SPRUCE CIR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4323
Mailing Address - Country:US
Mailing Address - Phone:415-891-9481
Mailing Address - Fax:
Practice Address - Street 1:285 E MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2912
Practice Address - Country:US
Practice Address - Phone:631-265-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039816122300000X
CT10868122300000X
NY0577001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist