Provider Demographics
NPI:1184030926
Name:TRAN, MY THI (DMD)
Entity type:Individual
Prefix:
First Name:MY THI
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 WOOD HOLLOW DR APT 105R
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3102
Mailing Address - Country:US
Mailing Address - Phone:205-382-2873
Mailing Address - Fax:
Practice Address - Street 1:401 ED SCHMIDT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5715
Practice Address - Country:US
Practice Address - Phone:512-846-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336151223G0001X
AL61141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice