Provider Demographics
NPI:1295183150
Name:WANG, MARK Y (DMD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:290 BAKER AVENUE
Mailing Address - Street 2:SUITE S-104
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-6611
Mailing Address - Fax:978-371-3041
Practice Address - Street 1:290 BAKER AVENUE
Practice Address - Street 2:SUITE S-104
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-6611
Practice Address - Fax:978-371-3041
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MADN187101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics