Provider Demographics
NPI:1457760027
Name:QIAN, QIAN AMY (DDS)
Entity type:Individual
Prefix:
First Name:QIAN
Middle Name:AMY
Last Name:QIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:QIAN
Other - Middle Name:
Other - Last Name:QIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9701 HARMON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177
Mailing Address - Country:US
Mailing Address - Phone:817-720-3035
Mailing Address - Fax:817-720-3036
Practice Address - Street 1:9701 HARMON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177
Practice Address - Country:US
Practice Address - Phone:817-720-3035
Practice Address - Fax:817-720-3036
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice