Provider Demographics
NPI:1194022327
Name:TRAN, THIEN TAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:THIEN
Middle Name:TAM
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 1:2528 SUNDANCE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5871
Mailing Address - Country:US
Mailing Address - Phone:469-774-1402
Mailing Address - Fax:
Practice Address - Street 1:225 NE 28TH ST STE 225
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-7205
Practice Address - Country:US
Practice Address - Phone:181-779-9506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry