Provider Demographics
NPI:1992088934
Name:TRAN, THANH T (DDS)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:T
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 1:10365 CAMINITO GOMA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1628
Mailing Address - Country:US
Mailing Address - Phone:858-353-2182
Mailing Address - Fax:
Practice Address - Street 1:709 CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2502
Practice Address - Country:US
Practice Address - Phone:760-746-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice