Provider Demographics
NPI:1891046090
Name:TRAN, DENNIS (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
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 1:2040 N LOOP 336 W STE 300
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3579
Mailing Address - Country:US
Mailing Address - Phone:936-756-1676
Mailing Address - Fax:
Practice Address - Street 1:2040 N LOOP 336 W STE 300
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3579
Practice Address - Country:US
Practice Address - Phone:936-756-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297771223E0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891046090OtherPERSONAL NPI
1891328761OtherPRACTICE NPI