Provider Demographics
NPI:1538535265
Name:TRAN, TERESA T (DDS, MS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:T
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 KENTUCKY DERBY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1140
Mailing Address - Country:US
Mailing Address - Phone:408-712-3069
Mailing Address - Fax:
Practice Address - Street 1:601 E WHITESTONE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9041
Practice Address - Country:US
Practice Address - Phone:408-712-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649591223X0400X
TX380311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics