Provider Demographics
NPI:1346812609
Name:WANG, OLIVER YUCHONG (DDS)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:YUCHONG
Last Name:WANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 HEATHERMOOR PARK DR N
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8242
Mailing Address - Country:US
Mailing Address - Phone:317-666-1817
Mailing Address - Fax:
Practice Address - Street 1:210 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-2233
Practice Address - Country:US
Practice Address - Phone:260-463-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013685A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist