Provider Demographics
NPI:1861703365
Name:XIONG, MAI JUA (DDS)
Entity type:Individual
Prefix:DR
First Name:MAI
Middle Name:JUA
Last Name:XIONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MENDOTA ST STE 107
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1096
Mailing Address - Country:US
Mailing Address - Phone:608-665-2725
Mailing Address - Fax:
Practice Address - Street 1:1320 MENDOTA ST STE 107
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1096
Practice Address - Country:US
Practice Address - Phone:608-665-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60691122300000X
MD15539122300000X
WI6671-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist