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General NPI Number Information
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NPI Number | 1831961978
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Entity Type | Organization
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Legal Business Name | JANE JIAO, DDS, MMSC INC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 2121 REDWOOD ST STE C
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City | VALLEJO
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State | CA
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Zip | 94590-3603
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Country | US
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Telephone | 707-648-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 REDWOOD ST STE C
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City | VALLEJO
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State | CA
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Zip | 94590-3603
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Country | US
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Telephone | 707-648-3600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANE JIAO
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Credential | DDS, MMSC
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Telephone | 650-888-9883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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