Provider Demographics
NPI:1902925647
Name:TRAN, PHUOC MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUOC
Middle Name:MINH
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 BROOKSIDE CT
Mailing Address - Street 2:SUITE #102
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7109
Mailing Address - Country:US
Mailing Address - Phone:513-755-2118
Mailing Address - Fax:513-755-5732
Practice Address - Street 1:8919 BROOKSIDE CT
Practice Address - Street 2:SUITE #102
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7109
Practice Address - Country:US
Practice Address - Phone:513-755-2118
Practice Address - Fax:513-755-5732
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300204261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice