Provider Demographics
NPI:1609968585
Name:WANG, GANG G (DMD)
Entity Type:Individual
Prefix:
First Name:GANG
Middle Name:G
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 1:412 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4824
Mailing Address - Country:US
Mailing Address - Phone:478-757-9800
Mailing Address - Fax:478-757-3271
Practice Address - Street 1:412 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4824
Practice Address - Country:US
Practice Address - Phone:478-757-9800
Practice Address - Fax:478-757-3271
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist