Provider Demographics
NPI:1053594077
Name:LI, XIAOJING (DMD,MSD,DSC)
Entity type:Individual
Prefix:DR
First Name:XIAOJING
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:DMD,MSD,DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WALNUT ST # S1
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7592
Mailing Address - Country:US
Mailing Address - Phone:508-416-6118
Mailing Address - Fax:
Practice Address - Street 1:235 WALNUT ST # S1
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7592
Practice Address - Country:US
Practice Address - Phone:508-416-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice