Provider Demographics
NPI:1679066526
Name:TRAN, TROY BANCHA (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:BANCHA
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 CANARIO DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-3771
Mailing Address - Country:US
Mailing Address - Phone:832-518-6943
Mailing Address - Fax:
Practice Address - Street 1:16415 CANARIO DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-3771
Practice Address - Country:US
Practice Address - Phone:832-518-6943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10145122300000X
FL23568122300000X
TX362921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist