Provider Demographics
NPI:1093442048
Name:WANG PERIODONTICS PLLC
Entity Type:Organization
Organization Name:WANG PERIODONTICS PLLC
Other - Org Name:MAPLE GROVE PERIODONTICS AND IMPLANT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:517-648-3576
Mailing Address - Street 1:18145 59TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3936
Mailing Address - Country:US
Mailing Address - Phone:517-648-3576
Mailing Address - Fax:
Practice Address - Street 1:12000 ELM CREEK BLVD N STE 320
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7076
Practice Address - Country:US
Practice Address - Phone:763-420-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty