Provider Demographics
NPI:1871930446
Name:TRAN VILLAS DENTAL PC
Entity type:Organization
Organization Name:TRAN VILLAS DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSAHUA
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-314-0750
Mailing Address - Street 1:26775 HAYWARD BLVD
Mailing Address - Street 2:STE P
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-2082
Mailing Address - Country:US
Mailing Address - Phone:510-314-0750
Mailing Address - Fax:510-314-0781
Practice Address - Street 1:26775 HAYWARD BLVD
Practice Address - Street 2:STE P
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-2082
Practice Address - Country:US
Practice Address - Phone:510-314-0750
Practice Address - Fax:510-314-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61168122300000X
CA60348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265626154OtherNPI JOSAHUA TRAN
CA1740474097OtherNPI VIRNA VILLAS