Provider Demographics
NPI:1952673584
Name:TRUONG, JENNIFER ANH-THU (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANH-THU
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LAS COLINAS BLVD W
Mailing Address - Street 2:APT 437
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5477
Mailing Address - Country:US
Mailing Address - Phone:714-604-9533
Mailing Address - Fax:
Practice Address - Street 1:2221 W LEDBETTER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4713
Practice Address - Country:US
Practice Address - Phone:214-234-8444
Practice Address - Fax:214-234-8448
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61100122300000X
TX29628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist