Provider Demographics
NPI:1174661813
Name:TRAN, TO-LOAN THI (DMD)
Entity Type:Individual
Prefix:MS
First Name:TO-LOAN
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 SE WESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6962
Mailing Address - Country:US
Mailing Address - Phone:503-408-8927
Mailing Address - Fax:503-408-8926
Practice Address - Street 1:1102 NE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5701
Practice Address - Country:US
Practice Address - Phone:503-408-8927
Practice Address - Fax:503-408-8926
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice