Provider Demographics
NPI:1407129331
Name:RICK VAN TRAN, DDS, INC
Entity Type:Organization
Organization Name:RICK VAN TRAN, DDS, INC
Other - Org Name:MANTECA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-823-9218
Mailing Address - Street 1:1007 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-5703
Mailing Address - Country:US
Mailing Address - Phone:209-823-9218
Mailing Address - Fax:209-823-1134
Practice Address - Street 1:1007 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5703
Practice Address - Country:US
Practice Address - Phone:209-823-9218
Practice Address - Fax:209-823-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty