Provider Demographics
NPI:1104040740
Name:JING, BOB X (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:X
Last Name:JING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1508
Mailing Address - Country:US
Mailing Address - Phone:214-738-1528
Mailing Address - Fax:214-987-9446
Practice Address - Street 1:2246 JACKSBORO HWY
Practice Address - Street 2:STE 112
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-2330
Practice Address - Country:US
Practice Address - Phone:214-738-1528
Practice Address - Fax:214-987-9446
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice