Provider Demographics
NPI:1598073652
Name:TRAN, ALISSA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NW SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1746
Mailing Address - Country:US
Mailing Address - Phone:515-964-1354
Mailing Address - Fax:
Practice Address - Street 1:211 NW SCHOOL ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1746
Practice Address - Country:US
Practice Address - Phone:515-964-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157521223X0400X
IA098521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics