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General NPI Number Information
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NPI Number | 1225853674
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Entity Type | Organization
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Legal Business Name | TRANSFORM DENTAL PLLC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 7915 US HIGHWAY 301 N STE 220
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City | ELLENTON
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State | FL
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Zip | 34222-3527
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Country | US
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Telephone | 941-315-5996
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Fax |
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Provider Business Mailing Address
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Address Line | 13819 CAMDEN CREST TER
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34211-1726
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Country | US
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Telephone | 772-263-6413
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VU HOANG TRAN
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Credential | DMD
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Telephone | 772-263-6413
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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 |
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License Number State |
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