Provider Demographics
NPI:1336551373
Name:TRAN, KHOA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KHOA
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 IVY LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2580
Mailing Address - Country:US
Mailing Address - Phone:508-282-9924
Mailing Address - Fax:
Practice Address - Street 1:72 GROVE ST
Practice Address - Street 2:#2
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3241
Practice Address - Country:US
Practice Address - Phone:508-541-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-26
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18569441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program