Basic Information
Provider Information
NPI: 1265854657
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRAN
FirstName: NGOC
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15951 LITTLE AXE DR
Address2:  
City: NORMAN
State: OK
PostalCode: 730269088
CountryCode: US
TelephoneNumber: 4054470300
FaxNumber: 4057017914
Practice Location
Address1: 15951 LITTLE AXE DR
Address2:  
City: NORMAN
State: OK
PostalCode: 730269088
CountryCode: US
TelephoneNumber: 4054470300
FaxNumber: 4057017914
Other Information
ProviderEnumerationDate: 01/20/2014
LastUpdateDate: 01/13/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X5096OKY Dental ProvidersDentist 

No ID Information.


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