Provider Demographics
NPI:1518205764
Name:XIN JENNY WANG, DMD PC
Entity Type:Organization
Organization Name:XIN JENNY WANG, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XIN
Authorized Official - Middle Name:JENNY
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-933-5023
Mailing Address - Street 1:110 WINN ST
Mailing Address - Street 2:STE. 206
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2897
Mailing Address - Country:US
Mailing Address - Phone:781-933-5023
Mailing Address - Fax:
Practice Address - Street 1:110 WINN ST
Practice Address - Street 2:STE. 206
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2897
Practice Address - Country:US
Practice Address - Phone:781-933-5023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty