Provider Demographics
NPI:1932425204
Name:TRINH, JESSIE (DMD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
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 1:5520 CANYON RD APT 1027
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-1822
Mailing Address - Country:US
Mailing Address - Phone:702-499-6330
Mailing Address - Fax:
Practice Address - Street 1:4545 BELLAIRE DR S STE 4
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1811
Practice Address - Country:US
Practice Address - Phone:817-731-8600
Practice Address - Fax:817-796-2404
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25313122300000X
CA591131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist