Provider Demographics
NPI:1568800464
Name:JIA, ZONGJIAN (DMD)
Entity Type:Individual
Prefix:
First Name:ZONGJIAN
Middle Name:
Last Name:JIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLACE NOTRE DAME
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-2223
Mailing Address - Country:US
Mailing Address - Phone:802-748-9357
Mailing Address - Fax:
Practice Address - Street 1:1 PLACE NOTRE DAME
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2223
Practice Address - Country:US
Practice Address - Phone:802-748-9357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.00959841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice