Provider Demographics
NPI:1790803310
Name:AILAN TRAN,D.D.S., A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:AILAN TRAN,D.D.S., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:AILAN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINH
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-528-7878
Mailing Address - Street 1:2042 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1357
Mailing Address - Country:US
Mailing Address - Phone:408-528-7878
Mailing Address - Fax:
Practice Address - Street 1:2042 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1357
Practice Address - Country:US
Practice Address - Phone:408-528-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43502OtherSTATE LICENCE
CAG91512-01Medicaid
CAD43502Medicaid
CA516896Medicaid
CA516896Medicaid