Provider Demographics
NPI:1407377401
Name:TRAN, TINA-THUY THANH (DMD)
Entity Type:Individual
Prefix:DR
First Name:TINA-THUY
Middle Name:THANH
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 1:4349 VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2330
Mailing Address - Country:US
Mailing Address - Phone:409-543-2289
Mailing Address - Fax:
Practice Address - Street 1:8035 MEMORIAL BLVD STE C
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-7002
Practice Address - Country:US
Practice Address - Phone:409-543-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice