MEDICARE: DR. ALLEN F. JUNG 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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1619984952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN F. JUNG D.D.S.

Provider Business Mailing Address
First Line	:	4155 147TH ST
Second Line	:
City	:	MIDLOTHIAN
State	:	IL
Zip	:	60445-3368
Country	:	US
Telephone Number	:	708-385-0990
Fax Number	:	708-385-0990

Provider Business Practice Location Address
First Line	:	4155 147TH ST
Second Line	:
City	:	MIDLOTHIAN
State	:	IL
Zip	:	60445-3368
Country	:	US
Telephone Number	:	708-385-0990
Fax Number	:	708-385-0990

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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