Healthcare Provider Details

I. General information

NPI: 1700358041
Provider Name (Legal Business Name): AMANDA TRAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 GEIGER RD
PHILADELPHIA PA
19115-1008
US

IV. Provider business mailing address

1601 SPRING GARDEN ST APT M111
PHILADELPHIA PA
19130-3942
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-2411
  • Fax:
Mailing address:
  • Phone: 215-255-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS042024
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDL14824
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS042024
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: