Provider Demographics
NPI:1699735886
Name:TRAN, JOHN L (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5852 N BROADWAY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4062
Mailing Address - Country:US
Mailing Address - Phone:773-878-2970
Mailing Address - Fax:773-878-8597
Practice Address - Street 1:5852 N BROADWAY ST
Practice Address - Street 2:STE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4061
Practice Address - Country:US
Practice Address - Phone:773-878-2970
Practice Address - Fax:773-878-8597
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist