Provider Demographics
NPI:1689750390
Name:TRAN, BRENT P (DDS)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:P
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-0112
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:10217 125TH STREET CT E
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2761
Practice Address - Country:US
Practice Address - Phone:253-864-4760
Practice Address - Fax:253-864-4558
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000095191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0174963OtherSTATE LABOR & INDUSTRIES
WA5044540Medicaid
WA4352TROtherREGENCE BLUE SHIELD