Provider Demographics
NPI:1558937458
Name:TRAN, HOA
Entity Type:Individual
Prefix:
First Name:HOA
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 SW 34TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1448
Mailing Address - Country:US
Mailing Address - Phone:352-665-1420
Mailing Address - Fax:
Practice Address - Street 1:7935 CONSTITUTION AVE STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80951-8903
Practice Address - Country:US
Practice Address - Phone:719-596-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002047151223G0001X
CODEN002047511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice