Provider Demographics
NPI:1184786204
Name:WANG, JENNY H
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:H
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13417 FORK RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9303
Mailing Address - Country:US
Mailing Address - Phone:410-817-9749
Mailing Address - Fax:410-893-7770
Practice Address - Street 1:2106 FALLSTON RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-1442
Practice Address - Country:US
Practice Address - Phone:410-893-0513
Practice Address - Fax:410-893-7770
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12274OtherMD STATE LICENSE
MDBW6109070OtherDEA #