Provider Demographics
NPI:1790948529
Name:TRAN, SHELLY XUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:XUAN
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 1:821 ALLEN ST
Mailing Address - Street 2:APT 1035
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5761
Mailing Address - Country:US
Mailing Address - Phone:832-677-3930
Mailing Address - Fax:
Practice Address - Street 1:821 ALLEN ST
Practice Address - Street 2:APT 1035
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5761
Practice Address - Country:US
Practice Address - Phone:832-677-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice