1447427463 NPI number — PHUOC THIEN LOUIS TRAN DDS., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447427463 NPI number — PHUOC THIEN LOUIS TRAN DDS., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHUOC THIEN LOUIS TRAN DDS., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
B TOWN FAMILY DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447427463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 BRUNDAGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93304-3211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-323-5400
Provider Business Mailing Address Fax Number:
661-323-6579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 BRUNDAGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93304-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-323-5400
Provider Business Practice Location Address Fax Number:
661-323-6579
Provider Enumeration Date:
05/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
PHUOC
Authorized Official Middle Name:
THIEN LOUIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
661-323-5400

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  48690 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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