1477656924 NPI number — DR. HUY B TRAN D.D.S.

Table of content: DR. HUY B TRAN D.D.S. (NPI 1477656924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477656924 NPI number — DR. HUY B TRAN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
HUY
Provider Middle Name:
B
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:
TRAN
Provider Other First Name:
CHRISTOPHER
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477656924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 MATLOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-466-8166
Provider Business Mailing Address Fax Number:
817-557-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 W MAYFIELD RD
Provider Second Line Business Practice Location Address:
STE. 302
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76014-2083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-466-8166
Provider Business Practice Location Address Fax Number:
817-557-4646
Provider Enumeration Date:
09/07/2006

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:  16548 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120852202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: D16548 . This is a "CHIPS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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