Provider Demographics
NPI:1265808786
Name:ANDREW TRAN, DDS, A DENTAL CORPORATION
Entity type:Organization
Organization Name:ANDREW TRAN, DDS, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-257-6453
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5084
Mailing Address - Country:US
Mailing Address - Phone:661-257-6453
Mailing Address - Fax:661-257-6450
Practice Address - Street 1:28212 KELLY JOHNSON PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5084
Practice Address - Country:US
Practice Address - Phone:661-257-6453
Practice Address - Fax:661-257-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty