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General NPI Number Information
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NPI Number | 1720226111
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Entity Type | Organization
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Legal Business Name | FMD ASSOCIATES
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 2021 JUSTIN RD STE 119
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City | FLOWER MOUND
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State | TX
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Zip | 75028-3836
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Country | US
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Telephone | 972-691-8337
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 JUSTIN RD STE 119
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City | FLOWER MOUND
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State | TX
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Zip | 75028-3836
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Country | US
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Telephone | 972-691-8337
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. WILLIAM ROBERT JENNINGS JR.
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Credential | DDS
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Telephone | 972-691-8337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18962
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License Number State | TX
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