Provider Demographics
NPI:1649229501
Name:BURKE, TRANG HOANG (DDS)
Entity type:Individual
Prefix:DR
First Name:TRANG
Middle Name:HOANG
Last Name:BURKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TRANG
Other - Middle Name:HUONG
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2039 BELLE CHASSE HWY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-6660
Mailing Address - Country:US
Mailing Address - Phone:504-367-9600
Mailing Address - Fax:504-366-5007
Practice Address - Street 1:2039 BELLE CHASSE HWY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-6660
Practice Address - Country:US
Practice Address - Phone:504-367-9600
Practice Address - Fax:504-366-5007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1848859Medicaid
LA070969OtherUNITED CONCORDIA PROVIDER
LAA2288OtherBLUE CROSS BLUE SHIELD #