Provider Demographics
NPI:1356865000
Name:WANG, QIAN
Entity type:Individual
Prefix:DR
First Name:QIAN
Middle Name:
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 1:220 S DENTON TAP RD STE 102
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5098
Mailing Address - Country:US
Mailing Address - Phone:469-619-6319
Mailing Address - Fax:
Practice Address - Street 1:220 S DENTON TAP RD STE 102
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5098
Practice Address - Country:US
Practice Address - Phone:469-619-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0259651223E0200X
TX393471223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics