Provider Demographics
NPI:1730232695
Name:TRAN, MYVAN T (DDS)
Entity type:Individual
Prefix:MRS
First Name:MYVAN
Middle Name:T
Last Name:TRAN
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 1:6117 LES DORSON LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3224
Mailing Address - Country:US
Mailing Address - Phone:703-924-1215
Mailing Address - Fax:
Practice Address - Street 1:5960 KINGSTOWNE CENTER BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315
Practice Address - Country:US
Practice Address - Phone:703-719-9210
Practice Address - Fax:703-719-6330
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice