Healthcare Provider Details

I. General information

NPI: 1467381335
Provider Name (Legal Business Name): TRA TRAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9118 EDINGER AVE
FOUNTAIN VALLEY CA
92708-1437
US

IV. Provider business mailing address

9118 EDINGER AVE
FOUNTAIN VALLEY CA
92708-1437
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-9551
  • Fax:
Mailing address:
  • Phone: 714-375-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TRA PHAM THANH TRAN
Title or Position: OWNER
Credential: DDS
Phone: 714-234-4351