MEDICARE: DR. JACKILYN DANG DMD

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	27231	TX
2	122300000X	Dentist	27231	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386923811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKILYN DANG DMD

Provider Business Mailing Address
First Line	:	3851 SW GREEN OAKS BLVD
Second Line	:	STE 101
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4130
Country	:	US
Telephone Number	:	817-789-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	3851 SW GREEN OAKS BLVD
Second Line	:	#100
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4130
Country	:	US
Telephone Number	:	817-789-4488
Fax Number	:	817-541-4471

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	01/03/2024

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