MEDICARE: DR. ALLISON M JUNG 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	122300000X	Dentist	00202555	CO

General Provider Information

NPI Number	:	1760865257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON M JUNG DDS

Provider Business Mailing Address
First Line	:	1927 WILMINGTON DR
Second Line	:	#202
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-6403
Country	:	US
Telephone Number	:	970-484-4850
Fax Number	:	970-484-2757

Provider Business Practice Location Address
First Line	:	1927 WILMINGTON DR
Second Line	:	#202
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-6403
Country	:	US
Telephone Number	:	970-484-4850
Fax Number	:	970-484-2757

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

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	11/14/2017

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