Basic Information
| Provider Information | |||||||||
| NPI: | 1588076335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | BRITNIE | ||||||||
| MiddleName: | NGUYETQUE | ||||||||
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| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 MEADOW VIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234353495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576736263 | ||||||||
| FaxNumber: | 7573923943 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 RIVER RD S | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278702244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844420231 | ||||||||
| FaxNumber: | 4344320425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2014 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 0401414441 | VA | Y | Dental Providers | Dentist | General Practice |
No ID Information.