Provider Demographics
NPI:1891283339
Name:WANG, JING (DMD)
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:
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 1:250 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3120
Mailing Address - Country:US
Mailing Address - Phone:617-282-6460
Mailing Address - Fax:
Practice Address - Street 1:250 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-3120
Practice Address - Country:US
Practice Address - Phone:617-282-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program