Provider Demographics
NPI:1376629659
Name:WANG, LI (DMD)
Entity Type:Individual
Prefix:DR
First Name:LI
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 1:860 HARRISON AVE
Mailing Address - Street 2:APT # 1206
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4002
Mailing Address - Country:US
Mailing Address - Phone:617-838-0889
Mailing Address - Fax:
Practice Address - Street 1:2181 WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2082
Practice Address - Country:US
Practice Address - Phone:617-427-5665
Practice Address - Fax:617-445-2708
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist