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General NPI Number Information
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NPI Number | 1972971992
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Entity Type | Individual
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Provider Name | DANIEL JIANG D.M.D. , M.M.SC
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Gender | Male
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 290 BAKER AVE STE 103
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City | CONCORD
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State | MA
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Zip | 01742-2189
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Country | US
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Telephone | 978-369-5521
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Fax |
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Provider Business Mailing Address
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Address Line | 290 BAKER AVE STE 103
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City | CONCORD
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State | MA
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Zip | 01742-2189
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Country | US
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Telephone | 978-369-5521
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN1857059
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License Number State | MA
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