Provider Demographics
NPI:1972971992
Name:JIANG, DANIEL (DMD , MMSC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:JIANG
Suffix:
Gender:M
Credentials:DMD , MMSC
Other - Prefix:DR
Other - First Name:WENHUI
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290 BAKER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2189
Mailing Address - Country:US
Mailing Address - Phone:978-369-5521
Mailing Address - Fax:
Practice Address - Street 1:290 BAKER AVE STE 103
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2189
Practice Address - Country:US
Practice Address - Phone:978-369-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18570591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics