Provider Demographics
NPI:1457647752
Name:WANG, ERIC XIAOGU (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:XIAOGU
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 78TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1124
Mailing Address - Country:US
Mailing Address - Phone:646-895-2953
Mailing Address - Fax:
Practice Address - Street 1:245 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-4629
Practice Address - Country:US
Practice Address - Phone:973-256-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387811223G0001X
NJ22DI024883001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice