Provider Demographics
NPI:1619196839
Name:TRAN, TIN TRUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIN
Middle Name:TRUONG
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 1:6758 MCCART AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6357
Mailing Address - Country:US
Mailing Address - Phone:817-292-6203
Mailing Address - Fax:817-292-6279
Practice Address - Street 1:6758 MCCART AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6357
Practice Address - Country:US
Practice Address - Phone:817-292-6203
Practice Address - Fax:817-292-6279
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist