Provider Demographics
NPI:1477764231
Name:WANG, BOBBY Y (DDS)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:Y
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 1:888 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0235
Mailing Address - Country:US
Mailing Address - Phone:212-744-1409
Mailing Address - Fax:212-879-6873
Practice Address - Street 1:888 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0235
Practice Address - Country:US
Practice Address - Phone:212-744-1409
Practice Address - Fax:212-879-6873
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0459431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist