MEDICARE: DR. DIXIN WANG D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN25322	FL

General Provider Information

NPI Number	:	1023490026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIXIN WANG D.M.D.

Provider Business Mailing Address
First Line	:	1000 WOODCOCK RD STE. 120
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 WOODCOCK RD STE 120. ORLANDO, FL 32803
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-3603
Country	:	US
Telephone Number	:	717-759-4378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/25/2023

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