MEDICARE: DR. JEREMY MICHAEL UNGER D.D.S.

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	30-023019	OH
2	1223G0001X	General Practice Dentistry	32660	TX

General Provider Information

NPI Number	:	1033349428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY MICHAEL UNGER D.D.S.

Provider Business Mailing Address
First Line	:	9525 N. BEACH ST.
Second Line	:	SUITE 429
City	:	FORT WORTH
State	:	TX
Zip	:	76244
Country	:	US
Telephone Number	:	817-431-1860
Fax Number	:	817-431-1861

Provider Business Practice Location Address
First Line	:	9525 N. BEACH ST.
Second Line	:	SUITE 429
City	:	FORT WORTH
State	:	TX
Zip	:	76244
Country	:	US
Telephone Number	:	817-431-1860
Fax Number	:	817-431-1861

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

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	04/09/2018

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