Healthcare Provider Details

I. General information

NPI: 1073498341
Provider Name (Legal Business Name): CATHY TRAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD STE 101
POOLER GA
31322-4508
US

IV. Provider business mailing address

1850 BENTON BLVD UNIT 5111
SAVANNAH GA
31407-1186
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: