Healthcare Provider Details

I. General information

NPI: 1376687533
Provider Name (Legal Business Name): ROYAL CROWN DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14215 COIT RD #112
DALLAS TX
75254-2800
US

IV. Provider business mailing address

14215 COIT RD #112
DALLAS TX
75254-2800
US

V. Phone/Fax

Practice location:
  • Phone: 972-701-8282
  • Fax: 972-701-8284
Mailing address:
  • Phone: 972-701-8282
  • Fax: 972-701-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20717
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID DUC TRAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 972-701-8282