Provider Demographics
NPI:1023175890
Name:TRAN, CHARLES C (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:6175 STOCKTON BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-4523
Mailing Address - Country:US
Mailing Address - Phone:916-427-6263
Mailing Address - Fax:916-427-4843
Practice Address - Street 1:6930 65TH ST
Practice Address - Street 2:SUITE 107B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2343
Practice Address - Country:US
Practice Address - Phone:916-427-6263
Practice Address - Fax:916-427-4843
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2017-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA379431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37943-02Medicaid
CAB37943-01Medicaid