Provider Demographics
NPI:1336200575
Name:WEN, DANIAN (DDS)
Entity Type:Individual
Prefix:
First Name:DANIAN
Middle Name:
Last Name:WEN
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 1:87-08 JUSTICE AVE
Mailing Address - Street 2:APT 6H
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4578
Mailing Address - Country:US
Mailing Address - Phone:718-639-1985
Mailing Address - Fax:
Practice Address - Street 1:155 WEST 68TH STREET
Practice Address - Street 2:SUITE 226
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5824
Practice Address - Country:US
Practice Address - Phone:212-362-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0491871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice