Provider Demographics
NPI:1912349812
Name:XUE, JIN JIE (DMD)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:JIE
Last Name:XUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:XUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:BLDG 38801 ACADEMIC DR SUITE B & C
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5660
Mailing Address - Country:US
Mailing Address - Phone:706-787-6927
Mailing Address - Fax:706-787-2082
Practice Address - Street 1:BLDG 38801 ACADEMIC DR SUITE B & C
Practice Address - Street 2:USA DENTAC
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5660
Practice Address - Country:US
Practice Address - Phone:706-787-6927
Practice Address - Fax:706-787-2082
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist