Provider Demographics
NPI:1902537384
Name:JIAO, YIZU (DDS)
Entity Type:Individual
Prefix:
First Name:YIZU
Middle Name:
Last Name:JIAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S CAMELLIA ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6076
Mailing Address - Country:US
Mailing Address - Phone:734-277-1908
Mailing Address - Fax:
Practice Address - Street 1:100 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-1802
Practice Address - Country:US
Practice Address - Phone:734-277-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice