Provider Demographics
NPI:1124848528
Name:TRAN, TIMOTHY TAM
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:TAM
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11527 MOSSMORRAN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2137
Mailing Address - Country:US
Mailing Address - Phone:281-798-7025
Mailing Address - Fax:
Practice Address - Street 1:11527 MOSSMORRAN LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2137
Practice Address - Country:US
Practice Address - Phone:281-798-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist