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General NPI Number Information
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NPI Number | 1558655910
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Entity Type | Organization
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Legal Business Name | 1ST IMPRESSION DENTAL GROUP PLLC
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 3901 W GREEN OAKS BLVD SUITE D
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City | ARLINGTON
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State | TX
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Zip | 76016-2795
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Country | US
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Telephone | 817-704-3767
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 W GREEN OAKS BLVD SUITE D
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City | ARLINGTON
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State | TX
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Zip | 76016-2795
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Country | US
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Telephone | 817-704-3767
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTORIA T TRAN
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Credential | DDS
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Telephone | 650-817-5799
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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 | 25243
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License Number State | TX
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