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General NPI Number Information
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NPI Number | 1013410927
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Entity Type | Organization
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Legal Business Name | ANDY NGAN TRAN DMD INC.
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 2739 W EDINGER AVE
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City | SANTA ANA
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State | CA
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Zip | 92704-3523
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Country | US
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Telephone | 714-957-0308
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Fax | 714-957-5845
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Provider Business Mailing Address
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Address Line | 10106 STILBITE AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-1012
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Country | US
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Telephone | 714-307-9217
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. ANDY NGAN TRAN
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Credential | DMD
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Telephone | 714-307-9217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 64176
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License Number State | CA
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