1275715088 NPI number — CHI TRAN DANG DENTAL HYGIENIST

Table of content: CHI TRAN DANG DENTAL HYGIENIST (NPI 1275715088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275715088 NPI number — CHI TRAN DANG DENTAL HYGIENIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANG
Provider First Name:
CHI
Provider Middle Name:
TRAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTAL HYGIENIST
Provider Gender Code:
F

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:
1275715088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 340
Provider Second Line Business Mailing Address:
SANTO DOMINGO HEALTH CENTER
Provider Business Mailing Address City Name:
SANTO DOMINGO PUEBLO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87052-0340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-465-3078
Provider Business Mailing Address Fax Number:
505-465-1153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 WEST HIGHWAY 22
Provider Second Line Business Practice Location Address:
SANTO DOMINGO HEALTH CENTER
Provider Business Practice Location Address City Name:
SANTO DOMINGO PUEBLO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87052-0340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-465-3078
Provider Business Practice Location Address Fax Number:
505-465-1153
Provider Enumeration Date:
12/04/2007

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: 124Q00000X , with the licence number:  DH1438 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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