Provider Demographics
NPI:1578879110
Name:TRAN, JENNIFER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
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 1:271 GRAND ST
Mailing Address - Street 2:FL 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4464
Mailing Address - Country:US
Mailing Address - Phone:212-226-2161
Mailing Address - Fax:
Practice Address - Street 1:271 GRAND ST
Practice Address - Street 2:FL 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4464
Practice Address - Country:US
Practice Address - Phone:212-226-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0550591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program