Provider Demographics
NPI:1457186306
Name:WANG, AMY (DMD)
Entity type:Individual
Prefix:
First Name:AMY
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 1:6111 N DAVIS HWY STE C
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6913
Mailing Address - Country:US
Mailing Address - Phone:850-477-9798
Mailing Address - Fax:
Practice Address - Street 1:6111 N DAVIS HWY STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6913
Practice Address - Country:US
Practice Address - Phone:850-477-9798
Practice Address - Fax:850-479-1088
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist