Provider Demographics
NPI:1316264815
Name:TRINH, JENNIFER N (DMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:TRINH
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 1:1756 BROAD PARK CIR N
Mailing Address - Street 2:STE 100
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1756 BROAD PARK CIR N
Practice Address - Street 2:STE 100
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7821
Practice Address - Country:US
Practice Address - Phone:817-453-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253231223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice