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

Table of content: (NPI 1982269916)

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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