Provider Demographics
NPI:1952507022
Name:TRAN, AN XUAN (DMD)
Entity Type:Individual
Prefix:
First Name:AN
Middle Name:XUAN
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 1:540 FRESNO DRIVE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:NJ
Mailing Address - Zip Code:08049
Mailing Address - Country:US
Mailing Address - Phone:856-784-2858
Mailing Address - Fax:856-784-2858
Practice Address - Street 1:540 FRESNO DRIVE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:NJ
Practice Address - Zip Code:08049
Practice Address - Country:US
Practice Address - Phone:856-784-2858
Practice Address - Fax:856-784-2858
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02051500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist