Provider Demographics
NPI:1518104967
Name:TRAN, LANCE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:T
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 1:4025 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4703
Mailing Address - Country:US
Mailing Address - Phone:713-643-7673
Mailing Address - Fax:713-643-5534
Practice Address - Street 1:4025 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4703
Practice Address - Country:US
Practice Address - Phone:713-643-7673
Practice Address - Fax:713-643-5534
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1598838856OtherNPI TYPE II