Healthcare Provider Details

I. General information

NPI: 1083093231
Provider Name (Legal Business Name): KIMBERLY P TRAN D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 PANTOPS MOUNTAIN PL STE 1
CHARLOTTESVILLE VA
22911
US

IV. Provider business mailing address

632 E SANDY LAKE RD
COPPELL TX
75019-3019
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-1817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401415997
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: