Provider Demographics
NPI:1225699895
Name:TSAN, JADIETTE (DDS)
Entity Type:Individual
Prefix:
First Name:JADIETTE
Middle Name:
Last Name:TSAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 HAWAII DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6722
Mailing Address - Country:US
Mailing Address - Phone:214-604-4155
Mailing Address - Fax:
Practice Address - Street 1:2947 S BUCKNER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6953
Practice Address - Country:US
Practice Address - Phone:214-381-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice