Provider Demographics
NPI:1205896099
Name:WANG, WEN HSIU (DDS)
Entity type:Individual
Prefix:DR
First Name:WEN
Middle Name:HSIU
Last Name:WANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 N VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3702
Mailing Address - Country:US
Mailing Address - Phone:480-813-8280
Mailing Address - Fax:480-813-8329
Practice Address - Street 1:949 N VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3702
Practice Address - Country:US
Practice Address - Phone:480-813-8280
Practice Address - Fax:480-813-8329
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice