Healthcare Provider Details

I. General information

NPI: 1316163546
Provider Name (Legal Business Name): SON NAM TRAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W MCDERMOTT DR STE 100
ALLEN TX
75013-2777
US

IV. Provider business mailing address

508 W MCDERMOTT DR STE 100
ALLEN TX
75013-2777
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-9800
  • Fax:
Mailing address:
  • Phone: 972-747-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: