Provider Demographics
NPI:1235296633
Name:WANG, JENNY V (DDS)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:V
Last Name:WANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 W BELL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-583-8895
Mailing Address - Fax:623-975-7111
Practice Address - Street 1:15508 W BELL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-583-8895
Practice Address - Fax:623-975-7111
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD59441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ835340Medicare UPIN