Provider Demographics
NPI:1720078769
Name:WANG, IVY X (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVY
Middle Name:X
Last Name:WANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:XIANGYI
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2 MOTT ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5003
Mailing Address - Country:US
Mailing Address - Phone:212-732-5875
Mailing Address - Fax:
Practice Address - Street 1:2 MOTT ST
Practice Address - Street 2:SUITE #303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5003
Practice Address - Country:US
Practice Address - Phone:212-732-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0490141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice