Provider Demographics
NPI:1538418835
Name:XIA, FANG (DMD)
Entity type:Individual
Prefix:DR
First Name:FANG
Middle Name:
Last Name:XIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61-2 DREXELBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5378
Mailing Address - Country:US
Mailing Address - Phone:434-806-6423
Mailing Address - Fax:
Practice Address - Street 1:14 MACDADE BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-1806
Practice Address - Country:US
Practice Address - Phone:484-652-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0393031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice