Provider Demographics
NPI:1083805303
Name:XIE, JIAFANG (DMD)
Entity Type:Individual
Prefix:
First Name:JIAFANG
Middle Name:
Last Name:XIE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 S MASON RD STE N
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1764
Mailing Address - Country:US
Mailing Address - Phone:281-395-5800
Mailing Address - Fax:281-395-5803
Practice Address - Street 1:2944 S MASON RD STE N
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1764
Practice Address - Country:US
Practice Address - Phone:281-395-5800
Practice Address - Fax:281-395-5803
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice