Healthcare Provider Details

I. General information

NPI: 1285204206
Provider Name (Legal Business Name): AMELIA TRAN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NASHVILLE HWY
COLUMBIA TN
38401-2016
US

IV. Provider business mailing address

448 HIGHPOINT TER
BRENTWOOD TN
37027-8841
US

V. Phone/Fax

Practice location:
  • Phone: 931-490-3488
  • Fax:
Mailing address:
  • Phone: 870-833-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11493
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: