MEDICARE: DUYEN TRAN DMD PLLC

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	22149	TX

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	:	1730342825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUYEN TRAN DMD PLLC

Provider Business Mailing Address
First Line	:	2417 PARK HILL DR
Second Line	:	STE B
City	:	FORT WORTH
State	:	TX
Zip	:	76110-2200
Country	:	US
Telephone Number	:	817-921-2900
Fax Number	:	817-921-2902

Provider Business Practice Location Address
First Line	:	2417 PARK HILL DR
Second Line	:	STE B
City	:	FORT WORTH
State	:	TX
Zip	:	76110-2200
Country	:	US
Telephone Number	:	817-921-2900
Fax Number	:	817-921-2902

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DUYEN TRAN
Credential	:	DMD
Telephone Number	:	817-921-2900

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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