Provider Demographics
NPI:1578055448
Name:TRAN, ANDREW NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NGOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:HUNG
Other - Middle Name:NGOC
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1536 E NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5607
Mailing Address - Country:US
Mailing Address - Phone:601-466-6417
Mailing Address - Fax:
Practice Address - Street 1:555 GRANTS FERRY RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-9023
Practice Address - Country:US
Practice Address - Phone:601-992-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4003-181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice