Provider Demographics
NPI:1801317391
Name:TRAN, CHRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 E EXETER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3013
Mailing Address - Country:US
Mailing Address - Phone:714-235-7919
Mailing Address - Fax:
Practice Address - Street 1:18275 N 59TH AVE STE 128
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1252
Practice Address - Country:US
Practice Address - Phone:714-235-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1015021223G0001X
AZD0098551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice