MEDICARE: JEFFREY D. WING DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6263	AZ

General Provider Information

NPI Number	:	1275621047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY D. WING DDS, MS

Provider Business Mailing Address
First Line	:	3247 E PARK AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-4113
Country	:	US
Telephone Number	:	480-632-1269
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	SUITE #106
City	:	MESA
State	:	AZ
Zip	:	85212-2164
Country	:	US
Telephone Number	:	480-588-5437
Fax Number	:	480-588-7290

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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