1225243173 NPI number — DR. ANNE TRAN NGHIEM D.M.D.

Table of content: DR. ANNE TRAN NGHIEM D.M.D. (NPI 1225243173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225243173 NPI number — DR. ANNE TRAN NGHIEM D.M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAN
Provider Other First Name:
ANNE
Provider Other Middle Name:
UYEN Q.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225243173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 MADISON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH WINDSOR
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06074-2374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-778-4149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BIRNIE AVE
Provider Second Line Business Practice Location Address:
NO TOOTH LEFT BEHIND DENTAL CLINIC
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01107-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-787-7079
Provider Business Practice Location Address Fax Number:
413-736-4641
Provider Enumeration Date:
05/14/2007

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: 1223P0221X , with the licence number:  21421 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X , with the licence number: 009029 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0206369 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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