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General NPI Number Information
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NPI Number | 1700358041
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Entity Type | Individual
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Provider Name | AMANDA TRAN DMD
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Gender | Female
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 240 GEIGER RD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-1008
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Country | US
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Telephone | 215-464-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 SPRING GARDEN ST APT M111
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3942
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Country | US
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Telephone | 215-255-5907
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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 | DS042024
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License Number State | PA
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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 | DL14824
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS042024
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License Number State | PA
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