Provider Demographics
NPI:1366527913
Name:TRAN, PETER D (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:D
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:810 N PLANO RD
Mailing Address - Street 2:STE 210
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081
Mailing Address - Country:US
Mailing Address - Phone:972-699-9800
Mailing Address - Fax:972-863-9037
Practice Address - Street 1:810 N PLANO RD
Practice Address - Street 2:STE 210
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-7508
Practice Address - Country:US
Practice Address - Phone:972-699-9800
Practice Address - Fax:972-863-9037
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1482739-01Medicaid