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General NPI Number Information
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NPI Number | 1902063043
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Entity Type | Organization
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Legal Business Name | TRANDAI DENTAL CARE
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 5449 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-1703
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Country | US
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Telephone | 773-878-1009
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Fax |
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Provider Business Mailing Address
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Address Line | 5449 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-1703
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Country | US
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Telephone | 773-878-1009
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LINH THUY TRAN
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Credential | DMD
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Telephone | 773-878-1009
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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 | 019-026073
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License Number State | IL
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