Provider Demographics
NPI:1316201536
Name:TRAN, THAILONG BERNARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:THAILONG
Middle Name:BERNARD
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14207 PARK CENTER DR
Mailing Address - Street 2:STE 105
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5248
Mailing Address - Country:US
Mailing Address - Phone:301-776-9686
Mailing Address - Fax:
Practice Address - Street 1:14207 PARK CENTER DR
Practice Address - Street 2:STE 105
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5248
Practice Address - Country:US
Practice Address - Phone:301-776-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413856122300000X
MD16183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist