Basic Information
| Provider Information | |||||||||
| NPI: | 1558385351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | TU | ||||||||
| MiddleName: | MINH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 NORTHCHASE PKWY SE STE 150 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300676407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709165028 | ||||||||
| FaxNumber: | 6782477858 | ||||||||
| Practice Location | |||||||||
| Address1: | 1756 CANDLER RD | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300323277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709165028 | ||||||||
| FaxNumber: | 6782477858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 11/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DEN7829 | CO | N | Dental Providers | Dentist | General Practice | 1223G0001X | D4000 | SC | N | Dental Providers | Dentist | General Practice | 1223G0001X | 0401411091 | VA | N | Dental Providers | Dentist | General Practice | 1223G0001X | DN012562 | GA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 21450 | MA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 1201799A | IN | N | Dental Providers | Dentist | General Practice | 122300000X | DN012562 | GA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 000947009I | 05 | GA | MEDICAID | 000947009C | 05 | GA | MEDICAID | 000947009F | 05 | GA | MEDICAID | 000947009B | 05 | GA | MEDICAID | 000947009D | 05 | GA | MEDICAID | 000947009H | 05 | GA | MEDICAID | 000947009K | 05 | GA | MEDICAID | 9179164 | 05 | VA | MEDICAID | 000947009L | 05 | GA | MEDICAID | 009934653 | 05 | AL | MEDICAID |