Provider Demographics
NPI:1720226111
Name:FMD ASSOCIATES
Entity Type:Organization
Organization Name:FMD ASSOCIATES
Other - Org Name:FLOWER MOUND DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-691-8337
Mailing Address - Street 1:2021 JUSTIN RD STE 119
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3836
Mailing Address - Country:US
Mailing Address - Phone:972-691-8337
Mailing Address - Fax:
Practice Address - Street 1:2021 JUSTIN RD STE 119
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3836
Practice Address - Country:US
Practice Address - Phone:972-691-8337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty