Provider Demographics
NPI:1639609571
Name:TRAN, JENNIFER MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARY
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1612 HUGUENOT ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-791-9789
Mailing Address - Fax:804-419-1059
Practice Address - Street 1:12040 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7689
Practice Address - Country:US
Practice Address - Phone:804-364-7010
Practice Address - Fax:804-364-7017
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2021-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA04014156751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice