Healthcare Provider Details

I. General information

NPI: 1033436811
Provider Name (Legal Business Name): IRVING - DR LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E IRVING BLVD
IRVING TX
75060-4350
US

IV. Provider business mailing address

2476 WORTHINGTON ST
DALLAS TX
75204-2503
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-1400
  • 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/DENTIST
Credential: DDS
Phone: 972-747-1400