Provider Demographics
NPI:1790257780
Name:TRAN, DANIEL THE-ANH (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:THE-ANH
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 1:12453 TIMBERLAND BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5209
Mailing Address - Country:US
Mailing Address - Phone:817-431-2979
Mailing Address - Fax:817-776-5067
Practice Address - Street 1:12453 TIMBERLAND BLVD STE 113
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5209
Practice Address - Country:US
Practice Address - Phone:817-431-2979
Practice Address - Fax:817-776-5067
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX368141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program