Provider Demographics
NPI:1124037247
Name:WANG, SHU-HSIA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:SHU-HSIA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 FARM HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4248
Mailing Address - Country:US
Mailing Address - Phone:301-984-1985
Mailing Address - Fax:
Practice Address - Street 1:16037 COMPRINT CIR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1320
Practice Address - Country:US
Practice Address - Phone:301-977-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8204122300000X
VA6311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist