MEDICARE: JUN FAMILY DENTISTRY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700226651	OTHER	TX	NPPES

General Provider Information

NPI Number	:	1588220479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUN FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	4605 W BAILEY BOSWELL RD STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-4327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4605 W BAILEY BOSWELL RD STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-4327
Country	:	US
Telephone Number	:	682-250-2080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JIMMY NGUYEN
Credential	:	DDS
Telephone Number	:	682-250-2080

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	05/15/2019

Similar Medicare Providers

1700226651 — JIMMY U. NGUYEN DDS
Practice Location Address:

4605 W BAILEY BOSWELL RD STE 140
FORT WORTH, TX
76179-4327

Practice Phone: 682-250-2080
Practice Fax:

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Practice Location Address:

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1689300816 — FABIANA BASTOS VILLARI DPT
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1215820188 — TIESHA SHAKEMA' FENWICK
Practice Location Address:

4617 W BAILEY BOSWELL RD
FORT WORTH, TX
76179-4327

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Practice Fax:

1538118443 — FROOD EELANI, D.O PA
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1417977703 — FROOD EELANI DO
Practice Location Address:

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Practice Fax: 817-921-0391

Directions to “JUN FAMILY DENTISTRY ” Practice Location

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