Provider Demographics
NPI:1558385351
Name:TRAN, TU MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TU
Middle Name:MINH
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 1:1090 NORTHCHASE PKWY SE STE 150
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6407
Mailing Address - Country:US
Mailing Address - Phone:770-916-5028
Mailing Address - Fax:678-247-7858
Practice Address - Street 1:1756 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3277
Practice Address - Country:US
Practice Address - Phone:770-916-5028
Practice Address - Fax:678-247-7858
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN78291223G0001X
SCD40001223G0001X
VA04014110911223G0001X
GADN0125621223G0001X, 122300000X
MA214501223G0001X
IN1201799A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000947009IMedicaid
GA000947009CMedicaid
GA000947009FMedicaid
GA000947009BMedicaid
GA000947009DMedicaid
GA000947009HMedicaid
GA000947009KMedicaid
VA9179164Medicaid
GA000947009LMedicaid
AL009934653Medicaid