MEDICARE: HOA TRAN

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	DEN.00204715	CO
2	1223G0001X	General Practice Dentistry	DEN00204751	CO

General Provider Information

NPI Number	:	1558937458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOA TRAN

Provider Business Mailing Address
First Line	:	4415 SW 34TH ST APT 101
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1448
Country	:	US
Telephone Number	:	352-665-1420
Fax Number	:

Provider Business Practice Location Address
First Line	:	7935 CONSTITUTION AVE STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-8903
Country	:	US
Telephone Number	:	719-596-9668
Fax Number	:

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

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/02/2021

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Directions to “ HOA TRAN ” Practice Location

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