Provider Demographics
NPI:1275104630
Name:WANG, CHENYU (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHENYU
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:39A BAKER RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6626
Mailing Address - Country:US
Mailing Address - Phone:267-566-0467
Mailing Address - Fax:
Practice Address - Street 1:334 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-7167
Practice Address - Country:US
Practice Address - Phone:207-204-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist