Provider Demographics
NPI:1710102736
Name:TRAN, TIMMIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMMIE
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 N GALLOWAY AVE
Mailing Address - Street 2:#128
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6365
Mailing Address - Country:US
Mailing Address - Phone:972-279-4411
Mailing Address - Fax:972-279-4411
Practice Address - Street 1:2411 N GALLOWAY AVE
Practice Address - Street 2:#128
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6365
Practice Address - Country:US
Practice Address - Phone:972-279-4411
Practice Address - Fax:972-279-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist