Provider Demographics
NPI:1821721267
Name:WANG, DEBERA SHU-MIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBERA
Middle Name:SHU-MIN
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 1:2045 KEIM DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2861
Mailing Address - Country:US
Mailing Address - Phone:630-631-6342
Mailing Address - Fax:
Practice Address - Street 1:1564 W LANE RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1903
Practice Address - Country:US
Practice Address - Phone:815-749-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE613160131223G0001X
IL0190347311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice