Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5393-015 | WI |
NPI | 1003908328 |
---|---|
Provider Name | Dr. Brian Haiho Tran |
First Address | Wellesley, MA 02482-3744 |
Second Address | Brookfield, WI 53005-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 30/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33780400 | (05) | WI |