MEDICARE: DR. JAMES M JERNIGAN DDS

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	22494	TX
2	1223G0001X	General Practice Dentistry	22494	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

General Provider Information

NPI Number	:	1477674299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M JERNIGAN DDS

Provider Business Mailing Address
First Line	:	4807 MAPLE AVE
Second Line	:	SUITE 300
City	:	DALLAS
State	:	TX
Zip	:	75219-1006
Country	:	US
Telephone Number	:	214-431-3727
Fax Number	:	214-635-3803

Provider Business Practice Location Address
First Line	:	4807 MAPLE AVE
Second Line	:	SUITE 300
City	:	DALLAS
State	:	TX
Zip	:	75219-1006
Country	:	US
Telephone Number	:	214-431-3727
Fax Number	:	214-635-3803

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	10/13/2011

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