Provider Demographics
NPI:1639281892
Name:MARK Y WANG
Entity Type:Organization
Organization Name:MARK Y WANG
Other - Org Name:CONCORD DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-369-6611
Mailing Address - Street 1:290 BAKER AVE
Mailing Address - Street 2:SUITE S104
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-6611
Mailing Address - Fax:978-371-3041
Practice Address - Street 1:290 BAKER AVE
Practice Address - Street 2:SUITE S104
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-6611
Practice Address - Fax:978-371-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty