Provider Demographics
NPI:1447713524
Name:XIAO, JIANQIANG (DMD)
Entity type:Individual
Prefix:DR
First Name:JIANQIANG
Middle Name:
Last Name:XIAO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 SOUTH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1356
Mailing Address - Country:US
Mailing Address - Phone:908-889-2020
Mailing Address - Fax:908-889-8411
Practice Address - Street 1:346 SOUTH AVE STE 7
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1356
Practice Address - Country:US
Practice Address - Phone:908-889-2020
Practice Address - Fax:908-889-8411
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02784400122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist