Healthcare Provider Details

I. General information

NPI: 1336099365
Provider Name (Legal Business Name): JESSICA TRIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 S ORANGE AVE STE 180
ORLANDO FL
32806-5459
US

IV. Provider business mailing address

2845 S ORANGE AVE STE 180
ORLANDO FL
32806-5459
US

V. Phone/Fax

Practice location:
  • Phone: 407-734-1882
  • Fax:
Mailing address:
  • Phone: 407-734-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: