Provider Demographics
NPI:1679029813
Name:XIA, JESSICA YENING (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:YENING
Last Name:XIA
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 1:110 SAN ANTONIO ST.
Mailing Address - Street 2:APT 617
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701
Mailing Address - Country:US
Mailing Address - Phone:516-603-1066
Mailing Address - Fax:
Practice Address - Street 1:15004 AVERY RANCH BLVD
Practice Address - Street 2:BUILDING A #100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717
Practice Address - Country:US
Practice Address - Phone:512-246-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice