Provider Demographics
NPI:1689653966
Name:TRAN, TRONG TU (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRONG
Middle Name:TU
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 TULLY ROAD, SUITE 108
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111
Mailing Address - Country:US
Mailing Address - Phone:408-270-4849
Mailing Address - Fax:408-270-0105
Practice Address - Street 1:88 TULLY ROAD, SUITE 108
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111
Practice Address - Country:US
Practice Address - Phone:408-270-4849
Practice Address - Fax:408-270-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist