Provider Demographics
NPI:1457765778
Name:DU, JINCHENG (DDS)
Entity Type:Individual
Prefix:
First Name:JINCHENG
Middle Name:
Last Name:DU
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 1:2485 FORT CAMPBELL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7787
Mailing Address - Country:US
Mailing Address - Phone:931-431-0200
Mailing Address - Fax:
Practice Address - Street 1:2485 FORT CAMPBELL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-7787
Practice Address - Country:US
Practice Address - Phone:931-431-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist