MEDICARE: JEREMY M UNGER DDS PLLC

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	32660	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1033349428	OTHER	TX	NPI TYPE 1

General Provider Information

NPI Number	:	1083137483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEREMY M UNGER DDS PLLC

Provider Business Mailing Address
First Line	:	9525 N BEACH ST
Second Line	:	STE 429
City	:	FORT WORTH
State	:	TX
Zip	:	76244
Country	:	US
Telephone Number	:	614-378-9578
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 N BEACH ST
Second Line	:	STE 429
City	:	FORT WORTH
State	:	TX
Zip	:	76244
Country	:	US
Telephone Number	:	614-378-9578
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMY MICHAEL UNGER
Credential	:	DDS
Telephone Number	:	614-378-9578

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	07/21/2022

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