Provider Demographics
NPI:1528305265
Name:TERRIE X TRAN DDS PC
Entity type:Organization
Organization Name:TERRIE X TRAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DESPIGANOVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-492-9399
Mailing Address - Street 1:10545 S. EASTERN AVE 140
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3973
Mailing Address - Country:US
Mailing Address - Phone:702-492-9399
Mailing Address - Fax:702-492-6326
Practice Address - Street 1:10545 S EASTERN AVE STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3973
Practice Address - Country:US
Practice Address - Phone:702-492-9399
Practice Address - Fax:702-492-6326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NV4178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty