MEDICARE: DR. BOB X. JING DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19270	TX

General Provider Information

NPI Number	:	1104040740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOB X. JING DDS

Provider Business Mailing Address
First Line	:	2925 WESTMINSTER AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-1508
Country	:	US
Telephone Number	:	214-738-1528
Fax Number	:	214-987-9446

Provider Business Practice Location Address
First Line	:	2246 JACKSBORO HWY
Second Line	:	STE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76114-2330
Country	:	US
Telephone Number	:	214-738-1528
Fax Number	:	214-987-9446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	09/11/2008

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