Provider Demographics
NPI:1619510088
Name:NANCY JIANG DENTAL GROUP INC
Entity Type:Organization
Organization Name:NANCY JIANG DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XINYI
Authorized Official - Middle Name:
Authorized Official - Last Name:JIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:765-237-2036
Mailing Address - Street 1:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-6322
Mailing Address - Country:US
Mailing Address - Phone:765-237-2036
Mailing Address - Fax:
Practice Address - Street 1:2100 CARLMONT DR STE 8
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3465
Practice Address - Country:US
Practice Address - Phone:650-830-7632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental