Provider Demographics
NPI:1760093397
Name:ZHANG, GRACE JIE (DMD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:JIE
Last Name:ZHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 SIERRA SECO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1969
Mailing Address - Country:US
Mailing Address - Phone:210-882-8013
Mailing Address - Fax:
Practice Address - Street 1:1677 RIVER RD STE 103
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2483
Practice Address - Country:US
Practice Address - Phone:830-331-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice