Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401411355 | VA |
N | 1223X0400X | Orthodontists | 12113 | MA |
NPI | 1073651873 |
---|---|
Provider Name | Anh N Tran |
First Address | N Potomac, MD 20878 |
Second Address | Chester, VA 23831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |