Healthcare Provider Details

I. General information

NPI: 1104497106
Provider Name (Legal Business Name): ERIC TRAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 BLUE OAKS BLVD
ROSEVILLE CA
95747-7143
US

IV. Provider business mailing address

5001 RECITAL WAY
ROSEVILLE CA
95747-8934
US

V. Phone/Fax

Practice location:
  • Phone: 916-797-0825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number106512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number106512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: