MEDICARE: DENTISTRY OF BROWNSVILLE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1265697858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY OF BROWNSVILLE, PC

Provider Business Mailing Address
First Line	:	400 GALLERIA PKWY SE STE 800
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6413
Country	:	US
Telephone Number	:	800-927-9947
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 VETERANS BLVD
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78840-3302
Country	:	US
Telephone Number	:	800-920-9947
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TU M TRAN
Credential	:	DDS
Telephone Number	:	770-916-5028

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	07/23/2008

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