Provider Demographics
NPI:1912107053
Name:PHAN-TRAN, XUAN LAN THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:XUAN LAN
Middle Name:THI
Last Name:PHAN-TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:XUAN LAN
Other - Middle Name:THI
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:903 S ASHLAND AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4096
Mailing Address - Country:US
Mailing Address - Phone:312-829-4011
Mailing Address - Fax:
Practice Address - Street 1:1140 W ARGYLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3610
Practice Address - Country:US
Practice Address - Phone:773-271-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice