Provider Demographics
NPI:1811393598
Name:TRAN, D.D.S., PC
Entity Type:Organization
Organization Name:TRAN, D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-550-1491
Mailing Address - Street 1:4365 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4816
Mailing Address - Country:US
Mailing Address - Phone:619-550-1491
Mailing Address - Fax:619-255-5437
Practice Address - Street 1:4365 MEADE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4816
Practice Address - Country:US
Practice Address - Phone:619-550-1491
Practice Address - Fax:619-255-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty