Healthcare Provider Details

I. General information

NPI: 1184508749
Provider Name (Legal Business Name): JENNIFER BANG TRINH NGUYEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 HOGAN ST BLDG 1855
FORT CARSON CO
80913-4408
US

IV. Provider business mailing address

655 S SIERRA MADRE ST APT 130
COLORADO SPRINGS CO
80903-4118
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-5400
  • Fax:
Mailing address:
  • Phone: 571-294-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419476
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: