Provider Demographics
NPI:1205309796
Name:MARY QIAN DENTAL GROUP
Entity type:Organization
Organization Name:MARY QIAN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:QIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-327-3172
Mailing Address - Street 1:888 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2915
Mailing Address - Country:US
Mailing Address - Phone:650-327-3172
Mailing Address - Fax:650-323-5013
Practice Address - Street 1:888 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2915
Practice Address - Country:US
Practice Address - Phone:650-327-3172
Practice Address - Fax:650-323-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental