Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 31157 | TX |
NPI | 1003292491 |
---|---|
Provider Name | Van Thanh Tran |
First Address | Dallas, TX 75287-7319 |
Second Address | Dallas, TX 75220-6751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2015 |
Last Update Date | 07/08/2015 |