Basic Information
| Provider Information | |||||||||
| NPI: | 1205359130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | NGUYEN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8911 GLENEAGLES CIR | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926836829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144001169 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 40760 CALIFORNIA OAKS RD | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925625791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516773078 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2017 | ||||||||
| LastUpdateDate: | 07/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 101503 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.