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General NPI Number Information
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NPI Number | 1255409967
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Entity Type | Individual
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Provider Name | DOAN KHANH TRAN D.M.D
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 3661 SANGANI BLVD
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City | DIBERVILLE
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State | MS
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Zip | 39540-8706
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Country | US
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Telephone | 228-269-0175
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Fax |
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Provider Business Mailing Address
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Address Line | 2258 W ROOSEVELT BLVD STE A
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City | MONROE
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State | NC
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Zip | 28110-3090
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Country | US
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Telephone | 704-291-7100
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Fax | 704-291-7115
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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 | 4271-22
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D8655
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License Number State | OR
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