Healthcare Provider Details

I. General information

NPI: 1942439492
Provider Name (Legal Business Name): TRUNG THANH TRAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9607 E 95TH CT S
TULSA OK
74133-5839
US

IV. Provider business mailing address

9607 E 95TH CT S
TULSA OK
74133-5839
US

V. Phone/Fax

Practice location:
  • Phone: 918-288-0818
  • Fax:
Mailing address:
  • Phone: 918-812-3548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number65
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6119
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: