Provider Demographics
NPI:1548432271
Name:TRICIA T. TRAN, D.D.S., P.C.
Entity Type:Organization
Organization Name:TRICIA T. TRAN, D.D.S., P.C.
Other - Org Name:KIDZ DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-222-0111
Mailing Address - Street 1:6101 REDWOOD SQUARE CIRCLE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121
Mailing Address - Country:US
Mailing Address - Phone:703-222-0111
Mailing Address - Fax:703-222-0888
Practice Address - Street 1:6101 REDWOOD SQUARE CIRCLE
Practice Address - Street 2:SUITE 300
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121
Practice Address - Country:US
Practice Address - Phone:703-222-0111
Practice Address - Fax:703-222-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9179211/10715Medicaid