Provider Demographics
NPI:1215231089
Name:TRAN, NHUNG THI (DMD)
Entity Type:Individual
Prefix:
First Name:NHUNG
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 1:850 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1133
Mailing Address - Country:US
Mailing Address - Phone:617-825-0059
Mailing Address - Fax:617-265-3745
Practice Address - Street 1:850 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-1133
Practice Address - Country:US
Practice Address - Phone:617-825-0059
Practice Address - Fax:617-265-3745
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN15925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist