Provider Demographics
NPI:1609936277
Name:WANG, ALEXANDER I (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:I
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KNUTH ROAD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:561-738-9007
Mailing Address - Fax:561-738-9963
Practice Address - Street 1:200 KNUTH ROAD
Practice Address - Street 2:SUITE #106
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436
Practice Address - Country:US
Practice Address - Phone:561-738-9007
Practice Address - Fax:561-738-9963
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics