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General NPI Number Information
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NPI Number | 1679066526
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Entity Type | Individual
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Provider Name | TROY BANCHA TRAN DMD, MSD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 16415 CANARIO DR
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City | HOUSTON
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State | TX
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Zip | 77083-3771
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Country | US
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Telephone | 832-518-6943
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Fax |
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Provider Business Mailing Address
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Address Line | 16415 CANARIO DR
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City | HOUSTON
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State | TX
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Zip | 77083-3771
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Country | US
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Telephone | 832-518-6943
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10145
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23568
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 36292
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License Number State | TX
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