MEDICARE: DR. HENRY TRAN D.D.S.

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	122300000X	Dentist	53955	CA

General Provider Information

NPI Number	:	1407953797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY TRAN D.D.S.

Provider Business Mailing Address
First Line	:	4616 EL CAJON BLVD STE 8
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4426
Country	:	US
Telephone Number	:	619-280-0076
Fax Number	:	619-280-3526

Provider Business Practice Location Address
First Line	:	4616 EL CAJON BLVD STE 8
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4426
Country	:	US
Telephone Number	:	619-280-0076
Fax Number	:	619-280-3526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/04/2015

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