Provider Demographics
NPI:1679675011
Name:TRAN, JANET DIEM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:DIEM
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:DIEM
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:717 S GREENVILLE AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3317
Mailing Address - Country:US
Mailing Address - Phone:214-547-8628
Mailing Address - Fax:214-547-8675
Practice Address - Street 1:717 S GREENVILLE AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3317
Practice Address - Country:US
Practice Address - Phone:214-547-8628
Practice Address - Fax:214-547-8675
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148653204Medicaid
TX148653204Medicaid