Provider Demographics
NPI:1356454946
Name:TRAN, LAWRENCE L (DDS)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:L
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 1:80120 HIGHWAY 111
Mailing Address - Street 2:SUITE #3
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-775-9901
Mailing Address - Fax:760-775-9902
Practice Address - Street 1:80120 HIGHWAY 111
Practice Address - Street 2:SUITE #3
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-775-9901
Practice Address - Fax:760-775-9902
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB45993-01OtherDENTICAL