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General NPI Number Information
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NPI Number | 1124071873
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Entity Type | Individual
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Provider Name | ALYSSA ANN TRAN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 238 E BROADWAY
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City | SALEM
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State | NJ
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Zip | 08079-1108
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Country | US
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Telephone | 856-935-7711
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Fax | 856-935-9123
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Provider Business Mailing Address
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Address Line | PO BOX 1309
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City | MARLTON
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State | NJ
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Zip | 08053-6309
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Country | US
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Telephone | 609-567-0434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02609600
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License Number State | NJ
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