Provider Demographics
NPI:1619424561
Name:TRAN, PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11403 BARKER CYPRESS RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5425
Mailing Address - Country:US
Mailing Address - Phone:281-721-9575
Mailing Address - Fax:
Practice Address - Street 1:11403 BARKER CYPRESS RD STE 1300
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5425
Practice Address - Country:US
Practice Address - Phone:281-721-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist