MEDICARE: JINCHENG DU 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	122300000X	Dentist	9842	TN

General Provider Information

NPI Number	:	1457765778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINCHENG DU D.D.S.

Provider Business Mailing Address
First Line	:	2485 FORT CAMPBELL BLVD
Second Line	:	SUITE 101
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-7787
Country	:	US
Telephone Number	:	931-431-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2485 FORT CAMPBELL BLVD
Second Line	:	SUITE 101
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-7787
Country	:	US
Telephone Number	:	931-431-0200
Fax Number	:

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

Provider Enumeration Date	:	06/14/2014
Last Update Date	:	03/17/2025

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