MEDICARE: JSDENTAL, PC

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

General Provider Information

NPI Number	:	1063777993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSDENTAL, PC

Provider Business Mailing Address
First Line	:	9968 BELLAIRE BLVD STE 170
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9968 BELLAIRE BLVD STE 170
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3462
Country	:	US
Telephone Number	:	713-774-2100
Fax Number	:	713-774-2101

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JIAN FENG
Credential	:
Telephone Number	:	713-774-2100

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	07/06/2012

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Directions to “JSDENTAL, PC ” Practice Location

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