Provider Demographics
NPI:1548791049
Name:WANG, ANNE (DMD)
Entity Type:Individual
Prefix:
First Name:ANNE
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 1:1100 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1322
Mailing Address - Country:US
Mailing Address - Phone:610-833-2520
Mailing Address - Fax:
Practice Address - Street 1:2265 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2231
Practice Address - Country:US
Practice Address - Phone:212-289-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0415971223G0001X
NY062386-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice