Basic Information
| Provider Information | |||||||||
| NPI: | 1932729480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 N 15TH ST APT 111 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191214591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107552060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6801 RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191282446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154836633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2020 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | PA | N | Hospitals | General Acute Care Hospital | Children | 1223P0221X | DS043165 | PA | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.