Provider Demographics
NPI:1083059893
Name:EILEEN WANG PLLC
Entity Type:Organization
Organization Name:EILEEN WANG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUQUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-489-8820
Mailing Address - Street 1:4300 GARRETT RD STE D
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3487
Mailing Address - Country:US
Mailing Address - Phone:919-489-8820
Mailing Address - Fax:919-489-8825
Practice Address - Street 1:4300 GARRETT RD STE D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3487
Practice Address - Country:US
Practice Address - Phone:919-489-8820
Practice Address - Fax:919-489-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty