Provider Demographics
NPI:1538264247
Name:DANG, TRAN BAO (DDS)
Entity type:Individual
Prefix:DR
First Name:TRAN
Middle Name:BAO
Last Name:DANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2934
Mailing Address - Country:US
Mailing Address - Phone:817-270-3700
Mailing Address - Fax:817-270-3711
Practice Address - Street 1:112 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2934
Practice Address - Country:US
Practice Address - Phone:817-270-3700
Practice Address - Fax:817-270-3711
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist