Provider Demographics
NPI:1417072729
Name:NGUYEN & TRAN DENTAL CORPORATION
Entity type:Organization
Organization Name:NGUYEN & TRAN DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:HUNG
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-543-6070
Mailing Address - Street 1:4048 DALE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9505
Mailing Address - Country:US
Mailing Address - Phone:209-543-6070
Mailing Address - Fax:209-545-7890
Practice Address - Street 1:4048 DALE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9505
Practice Address - Country:US
Practice Address - Phone:209-543-6070
Practice Address - Fax:209-545-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty