Provider Demographics
NPI:1427275478
Name:HALL, TRAM TRUONG (DDS)
Entity type:Individual
Prefix:
First Name:TRAM
Middle Name:TRUONG
Last Name:HALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30220 RANCHO VIEJO RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1568
Mailing Address - Country:US
Mailing Address - Phone:949-443-2300
Mailing Address - Fax:949-443-2323
Practice Address - Street 1:30220 RANCHO VIEJO RD STE D
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1568
Practice Address - Country:US
Practice Address - Phone:949-443-2300
Practice Address - Fax:949-443-2323
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1611808OtherUNITED CONCORDIA PROVIDER