MEDICARE: MAI TRAN DDS, MS, PA

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19892	TX

General Provider Information

NPI Number	:	1326157256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAI TRAN DDS, MS, PA

Provider Business Mailing Address
First Line	:	6012 W WILLIAM CANNON DR
Second Line	:	SUITE D-103
City	:	AUSTIN
State	:	TX
Zip	:	78749-1980
Country	:	US
Telephone Number	:	512-892-1188
Fax Number	:	512-892-0063

Provider Business Practice Location Address
First Line	:	6012 W WILLIAM CANNON DR
Second Line	:	SUITE D-103
City	:	AUSTIN
State	:	TX
Zip	:	78749-1980
Country	:	US
Telephone Number	:	512-892-1188
Fax Number	:	512-892-0063

Authorized Official
Title or Position	:	PRESIDENT/ORTHODONTIST
Name	:	MAI THI TRAN
Credential	:	DDS, MS
Telephone Number	:	512-892-1188

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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