1558385351 NPI number — DR. TU MINH TRAN D.D.S.

Table of content: DR. TU MINH TRAN D.D.S. (NPI 1558385351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558385351 NPI number — DR. TU MINH TRAN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
TU
Provider Middle Name:
MINH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1558385351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1090 NORTHCHASE PKWY SE STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067-6407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-916-5028
Provider Business Mailing Address Fax Number:
678-247-7858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1756 CANDLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30032-3277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-916-5028
Provider Business Practice Location Address Fax Number:
678-247-7858
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DEN7829 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: D4000 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 0401411091 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DN012562 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 21450 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 1201799A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DN012562 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000947009I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000947009C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000947009F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000947009B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000947009D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000947009H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000947009K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9179164 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000947009L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009934653 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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