Healthcare Provider Details

I. General information

NPI: 1124071873
Provider Name (Legal Business Name): ALYSSA ANN TRAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIEU-THUY ANH TRAN(NGUYEN) D.M.D.

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 E BROADWAY
SALEM NJ
08079-1108
US

IV. Provider business mailing address

PO BOX 1309
MARLTON NJ
08053-6309
US

V. Phone/Fax

Practice location:
  • Phone: 856-935-7711
  • Fax: 856-935-9123
Mailing address:
  • Phone: 609-567-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02609600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: