MEDICARE: BOB JING DDS PA

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

General Provider Information

NPI Number	:	1437304771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOB JING DDS PA

Provider Business Mailing Address
First Line	:	2925 WESTMINSTER AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-1508
Country	:	US
Telephone Number	:	214-987-9446
Fax Number	:	817-529-1795

Provider Business Practice Location Address
First Line	:	2246 JACKSBORO HWY
Second Line	:	SUITE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76114-2330
Country	:	US
Telephone Number	:	817-529-1799
Fax Number	:	817-529-1795

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BOB X JING
Credential	:	DDS
Telephone Number	:	214-738-1528

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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