| Garland Grove Dentistry | |
|
1213 W State St Ste A Garland TX 75040-6153 | |
| (972) 272-3585 | |
| Not Available |
| Full Name | Garland Grove Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 1213 W State St Ste A, Garland, Texas |
| Authorized Official Name and Position | Woo Sung Jung (DENTIST) |
| Authorized Official Contact | 9496890898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Garland Grove Dentistry 3220 Twist Trl Plano TX 75093-8431 Ph: (949) 680-0898 | Garland Grove Dentistry 1213 W State St Ste A Garland TX 75040-6153 Ph: (972) 272-3585 |
| NPI Number | 1649793316 |
|---|---|
| Provider Enumeration Date | 07/24/2017 |
| Last Update Date | 07/24/2017 |
| Medicare PECOS PAC ID | 5597006569 |
|---|---|
| Medicare Enrollment ID | O20190402000121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649793316 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 29318 (Texas) | Primary |
| Provider Name | Woo Sung Jung |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1689006215 PECOS PAC ID: 2769723733 Enrollment ID: I20190402000174 |
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