Healthcare Provider Details

I. General information

NPI: 1669166179
Provider Name (Legal Business Name): TIFFANY TRAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6306 KIRBY RD STE 201
CLINTON MD
20735-1336
US

IV. Provider business mailing address

6306 KIRBY RD STE 201
CLINTON MD
20735-1336
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-1331
  • Fax: 301-868-5003
Mailing address:
  • Phone: 301-868-1331
  • Fax: 301-868-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19027
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN2000501
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: