Provider Demographics
NPI:1790447431
Name:TRAN, JENNY (DMD)
Entity Type:Individual
Prefix:
First Name:JENNY
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 1:5920 W WILLIAM CANNON DR.
Mailing Address - Street 2:BLDG 6 SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:512-892-2273
Mailing Address - Fax:
Practice Address - Street 1:5920 W WILLIAM CANNON DR.
Practice Address - Street 2:BLDG 6 SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:512-892-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice