Provider Demographics
NPI:1265412126
Name:QUACH-MILLER, TRAN BAO (DMD)
Entity type:Individual
Prefix:DR
First Name:TRAN
Middle Name:BAO
Last Name:QUACH-MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TRAN
Other - Middle Name:BAO
Other - Last Name:QUACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:199 SW SHEVLIN HIXON DR STE A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3201
Mailing Address - Country:US
Mailing Address - Phone:541-330-5952
Mailing Address - Fax:
Practice Address - Street 1:199 SW SHEVLIN HIXON DR STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3201
Practice Address - Country:US
Practice Address - Phone:541-330-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS8596122300000X
HIDT2135122300000X
ORD9389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist