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General NPI Number Information
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NPI Number | 1780474320
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Entity Type | Individual
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Provider Name | THUY TRAN
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Gender |
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 06/08/2025
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Provider Practice Location Address
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Address Line | 4960 S EMERSON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-5937
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Country | US
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Telephone | 317-830-0428
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Fax |
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Provider Business Mailing Address
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Address Line | 9849 N ANCHOR BND
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-5511
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Country | US
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Telephone | 317-851-7581
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 12014782A
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License Number State | IN
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