Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 27883 | TX |
NPI | 1003177635 |
---|---|
Provider Name | Dr. Laney Tram Mai |
First Address | Mesquite, TX 75149-4363 |
Second Address | Mesquite, TX 75149-4363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 13/10/2013 |