Healthcare Provider Details

I. General information

NPI: 1952695348
Provider Name (Legal Business Name): DENTAL REPUBLIC - GARLAND, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N GARLAND AVE
GARLAND TX
75040-5646
US

IV. Provider business mailing address

2515 MCKINNEY AVE STE. 940
DALLAS TX
75201-1908
US

V. Phone/Fax

Practice location:
  • Phone: 214-703-0044
  • 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: DR. SON TRAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 972-747-1400