Provider Demographics
NPI:1437302981
Name:TRAN, LONG D (PHD, DDS)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:D
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 FUQUA ST
Mailing Address - Street 2:#10
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2510
Mailing Address - Country:US
Mailing Address - Phone:713-943-3456
Mailing Address - Fax:
Practice Address - Street 1:11011 FUQUA ST
Practice Address - Street 2:#10
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2510
Practice Address - Country:US
Practice Address - Phone:713-943-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110925802Medicaid