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General NPI Number Information
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NPI Number | 1811425507
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Entity Type | Organization
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Legal Business Name | JJ DENTAL PLLC
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 1101 ALEXIS CT # 101
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City | MANSFIELD
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State | TX
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Zip | 76063-3338
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Country | US
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Telephone | 817-466-1200
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Fax | 817-466-1201
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Provider Business Mailing Address
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Address Line | 1101 ALEXIS CT # 101
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City | MANSFIELD
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State | TX
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Zip | 76063-3338
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Country | US
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Telephone | 817-466-1200
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Fax | 817-466-1201
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIYOUNG M JUNG
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Credential | DDS
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Telephone | 469-583-4092
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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 | 31181
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License Number State | TX
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