Healthcare Provider Details

I. General information

NPI: 1154547057
Provider Name (Legal Business Name): DENTAL REPUBLIC - BUCKNER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 S BUCKNER BLVD
DALLAS TX
75227-8605
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 214-381-2020
  • 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 Number
License Number State

VIII. Authorized Official

Name: DR. SON TRAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 972-747-1400