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Organization
JAE DENTAL PLLC
Active
Organization
JAE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON TROY BACON D.D.S. (OWNER)
(817) 710-7443
Entity
Organization
Contact information
Practice address
201 S ROGERS RD, IRVING, TX 75060-2608
(817) 710-7443
(817) 710-1447
Mailing address
6726 CAMP BOWIE BLVD, FORT WORTH, TX 76116-7113
(817) 710-7443
(817) 710-7447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
24381
TX
Other
Enumeration date
08/16/2016
Last updated
08/16/2016
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