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General NPI Number Information
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NPI Number | 1861053613
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Entity Type | Individual
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Provider Name | TINA JIANG DDS
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 1700 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-2335
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Country | US
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Telephone | 702-774-5138
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 W CHARLESTON BLVD # MS 7424
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City | LAS VEGAS
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State | NV
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Zip | 89102-2335
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Country | US
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Telephone | 702-774-5138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | LL-554-21
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-5154
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60962154
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1
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License Number State | WA
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