Provider Demographics
NPI:1225609936
Name:TRAN, JIMMY (DMD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
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 1:7503 BALDWIN XING
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5690
Mailing Address - Country:US
Mailing Address - Phone:832-967-8627
Mailing Address - Fax:
Practice Address - Street 1:14570 WALLISVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4351
Practice Address - Country:US
Practice Address - Phone:713-453-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice