Provider Demographics
NPI:1124071873
Name:TRAN, ALYSSA ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:ANN
Last Name:TRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:DIEU-THUY
Other - Middle Name:ANH
Other - Last Name:TRAN(NGUYEN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-6309
Mailing Address - Country:US
Mailing Address - Phone:609-567-0434
Mailing Address - Fax:
Practice Address - Street 1:238 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1108
Practice Address - Country:US
Practice Address - Phone:856-935-7711
Practice Address - Fax:856-935-9123
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026096001223G0001X
PADS-031391-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0484784Medicaid