Provider Demographics
NPI:1306956693
Name:QBTRAN DMD PC
Entity type:Organization
Organization Name:QBTRAN DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF COMPANY
Authorized Official - Prefix:MR
Authorized Official - First Name:QUOCBAO
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:831-678-9352
Mailing Address - Street 1:2530 H DELA ROSA SR ST
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960
Mailing Address - Country:US
Mailing Address - Phone:831-678-9253
Mailing Address - Fax:831-678-9289
Practice Address - Street 1:2530 H DELA ROSA SR ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960
Practice Address - Country:US
Practice Address - Phone:831-678-9253
Practice Address - Fax:831-678-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty