Provider Demographics
NPI:1962554691
Name:TRAN, QUAN LUU (DMD)
Entity type:Individual
Prefix:DR
First Name:QUAN
Middle Name:LUU
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2134
Mailing Address - Country:US
Mailing Address - Phone:617-699-5760
Mailing Address - Fax:781-767-2205
Practice Address - Street 1:1062 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2134
Practice Address - Country:US
Practice Address - Phone:617-699-5760
Practice Address - Fax:781-767-2207
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice