Provider Demographics
NPI:1568664043
Name:IP, WANLENG (DDS)
Entity Type:Individual
Prefix:
First Name:WANLENG
Middle Name:
Last Name:IP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:IP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2678 WELSH ROAD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152
Mailing Address - Country:US
Mailing Address - Phone:215-673-4017
Mailing Address - Fax:215-677-5772
Practice Address - Street 1:2678 WELSH ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-673-4017
Practice Address - Fax:215-677-5772
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026522Y122300000X
NJDY17628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist