Provider Demographics
NPI:1790137545
Name:JANG, ADRIANNA MIRIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANNA
Middle Name:MIRIM
Last Name:JANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MI
Other - Middle Name:RIM
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:10288 77TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1133
Mailing Address - Country:US
Mailing Address - Phone:262-697-4222
Mailing Address - Fax:262-697-4370
Practice Address - Street 1:10288 77TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1133
Practice Address - Country:US
Practice Address - Phone:262-697-4222
Practice Address - Fax:262-697-4370
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist