Healthcare Provider Details

I. General information

NPI: 1760780589
Provider Name (Legal Business Name): XINGZHONG JOHN ZHANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 UNIVERSITY BLVD N
JACKSONVILLE FL
32211-3321
US

IV. Provider business mailing address

2800 UNIVERSITY BLVD N
JACKSONVILLE FL
32211-3321
US

V. Phone/Fax

Practice location:
  • Phone: 904-256-7846
  • Fax: 904-256-7889
Mailing address:
  • Phone: 904-256-7846
  • Fax: 904-256-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDTP548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: