Healthcare Provider Details

I. General information

NPI: 1407129331
Provider Name (Legal Business Name): RICK VAN TRAN, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 S MAIN ST
MANTECA CA
95337-5703
US

IV. Provider business mailing address

1007 S MAIN ST
MANTECA CA
95337-5703
US

V. Phone/Fax

Practice location:
  • Phone: 209-823-9218
  • Fax: 209-823-1134
Mailing address:
  • Phone: 209-823-9218
  • Fax: 209-823-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53036
License Number StateCA

VIII. Authorized Official

Name: DR. RICK VAN TRAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 209-823-9218