Provider Demographics
NPI:1376838508
Name:TRAN, TRACY T (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:T
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2990 BLACKBURN ST
Mailing Address - Street 2:#3140
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3113
Mailing Address - Country:US
Mailing Address - Phone:323-303-6291
Mailing Address - Fax:
Practice Address - Street 1:3401 GREENBRIAR
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-4652
Practice Address - Country:US
Practice Address - Phone:432-682-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX308181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program