Provider Demographics
NPI:1578086823
Name:WANG, FAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:FAN
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 1:6609 W SAM HOUSTON PKWY S STE 203
Mailing Address - Street 2:ZEN DENTAL CARE
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1645
Mailing Address - Country:US
Mailing Address - Phone:713-773-9889
Mailing Address - Fax:
Practice Address - Street 1:6609 W SAM HOUSTON PKWY S STE 203
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1645
Practice Address - Country:US
Practice Address - Phone:713-773-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328681223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health