Provider Demographics
NPI:1881852168
Name:QUACH, BAO TRAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:TRAN
Last Name:QUACH
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 1:7168 ROTHLAND ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-1832
Mailing Address - Country:US
Mailing Address - Phone:469-733-6529
Mailing Address - Fax:
Practice Address - Street 1:312 S BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-2614
Practice Address - Country:US
Practice Address - Phone:214-941-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist