Provider Demographics
NPI:1760673701
Name:TRAN, HARRIS PHUONG HONG (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:PHUONG HONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3993 LAKE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4493
Mailing Address - Country:US
Mailing Address - Phone:503-636-0055
Mailing Address - Fax:
Practice Address - Street 1:3993 LAKE GROVE AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4493
Practice Address - Country:US
Practice Address - Phone:503-636-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6714122300000X
ORD10134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist