Provider Demographics
NPI:1497737506
Name:PHUOC THIEN LOUIS TRAN DDS INC.
Entity Type:Organization
Organization Name:PHUOC THIEN LOUIS TRAN DDS INC.
Other - Org Name:SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHUOC
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-399-5788
Mailing Address - Street 1:715 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-3510
Mailing Address - Country:US
Mailing Address - Phone:661-399-5788
Mailing Address - Fax:661-399-4998
Practice Address - Street 1:715 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-3510
Practice Address - Country:US
Practice Address - Phone:661-399-5788
Practice Address - Fax:661-399-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty