Provider Demographics
NPI:1770006082
Name:JIANG, YUNTAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:YUNTAO
Middle Name:
Last Name:JIANG
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 1:60 CRITTENDEN BLVD APT 1302
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4012
Mailing Address - Country:US
Mailing Address - Phone:585-348-1511
Mailing Address - Fax:
Practice Address - Street 1:7885 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-6640
Practice Address - Country:US
Practice Address - Phone:904-240-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN228671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice