Healthcare Provider Details

I. General information

NPI: 1528305265
Provider Name (Legal Business Name): TERRIE X TRAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10545 S EASTERN AVE STE 140
HENDERSON NV
89052-3973
US

IV. Provider business mailing address

10545 S. EASTERN AVE 140
HENDERSON NV
89052-3973
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-9399
  • Fax: 702-492-6326
Mailing address:
  • Phone: 702-492-9399
  • Fax: 702-492-6326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4178
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA LEE DESPIGANOVICZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-492-9399