Provider Demographics
NPI:1558610139
Name:JANG, AUSTIN (DDS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:JANG
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 1:408 S RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-4687
Mailing Address - Country:US
Mailing Address - Phone:302-643-9978
Mailing Address - Fax:
Practice Address - Street 1:408 S RIDGE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-4687
Practice Address - Country:US
Practice Address - Phone:302-643-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0421441223E0200X
DEG1-00114751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodontics