Provider Demographics
NPI: | 1437514593 |
---|---|
Name: | TRAN KELLER DDS INCORPORATED |
Entity Type: | Organization |
Organization Name: | TRAN KELLER DDS INCORPORATED |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MIMI |
Authorized Official - Middle Name: | NHI-UYEN |
Authorized Official - Last Name: | TRAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 817-741-7000 |
Mailing Address - Street 1: | 891 KELLER PKWY |
Mailing Address - Street 2: | STE 203 |
Mailing Address - City: | KELLER |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76248-2482 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-741-7000 |
Mailing Address - Fax: | 817-745-1100 |
Practice Address - Street 1: | 891 KELLER PKWY |
Practice Address - Street 2: | STE 203 |
Practice Address - City: | KELLER |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76248-2482 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-741-7000 |
Practice Address - Fax: | 817-745-1100 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-12-16 |
Last Update Date: | 2015-12-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 20299 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |