Provider Demographics
NPI:1255409967
Name:TRAN, DOAN KHANH (DMD)
Entity type:Individual
Prefix:DR
First Name:DOAN
Middle Name:KHANH
Last Name:TRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 W ROOSEVELT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3090
Mailing Address - Country:US
Mailing Address - Phone:704-291-7100
Mailing Address - Fax:704-291-7115
Practice Address - Street 1:3661 SANGANI BLVD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-8706
Practice Address - Country:US
Practice Address - Phone:228-269-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4271-221223G0001X
ORD86551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919131Medicaid