Provider Demographics
NPI:1407953797
Name:TRAN, HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
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 1:4616 EL CAJON BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4426
Mailing Address - Country:US
Mailing Address - Phone:619-280-0076
Mailing Address - Fax:619-280-3526
Practice Address - Street 1:4616 EL CAJON BLVD STE 8
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4426
Practice Address - Country:US
Practice Address - Phone:619-280-0076
Practice Address - Fax:619-280-3526
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53955122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist