MEDICARE: HENRY T. TRAN D.D.S., INC

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	261QD0000X	Dental Clinic/Center	53955	CA

General Provider Information

NPI Number	:	1407243710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY T. TRAN D.D.S., INC

Provider Business Mailing Address
First Line	:	4616 EL CAJON BLVD STE 8
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4426
Country	:	US
Telephone Number	:	619-280-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 PARK BLVD STE 8
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2689
Country	:	US
Telephone Number	:	619-220-7000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HENRY TRAN
Credential	:	DDS
Telephone Number	:	619-280-0076

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	04/24/2015

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