Provider Demographics
NPI:1366339491
Name:TRAN, THI THANH THAO
Entity type:Individual
Prefix:
First Name:THI THANH THAO
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 SIR ALEXANDER LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5688
Mailing Address - Country:US
Mailing Address - Phone:972-876-2759
Mailing Address - Fax:
Practice Address - Street 1:3200 S LANCASTER RD # 183
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4555
Practice Address - Country:US
Practice Address - Phone:214-375-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist