Provider Demographics
NPI:1720363633
Name:WANG, MICHELLE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
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 1:1103 RIVERY BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3057
Mailing Address - Country:US
Mailing Address - Phone:512-763-7606
Mailing Address - Fax:888-552-5796
Practice Address - Street 1:1103 RIVERY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3057
Practice Address - Country:US
Practice Address - Phone:512-763-7606
Practice Address - Fax:888-552-5796
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX318671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice