Provider Demographics
NPI:1831961978
Name:JANE JIAO, DDS, MMSC INC
Entity type:Organization
Organization Name:JANE JIAO, DDS, MMSC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MMSC
Authorized Official - Phone:650-888-9883
Mailing Address - Street 1:2121 REDWOOD ST STE C
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3603
Mailing Address - Country:US
Mailing Address - Phone:707-648-3600
Mailing Address - Fax:
Practice Address - Street 1:2121 REDWOOD ST STE C
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3603
Practice Address - Country:US
Practice Address - Phone:707-648-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental