MEDICARE: NHUNG TRAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	010631	CT
2	122300000X	Dentist	62993	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285921015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NHUNG TRAN DMD

Provider Business Mailing Address
First Line	:	76 MANNING LN
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1614
Country	:	US
Telephone Number	:	860-978-0929
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 MANNING LN
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1614
Country	:	US
Telephone Number	:	860-978-0929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	11/12/2013

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