MEDICARE: 3-D DENTAL, PC

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	122300000X	Dentist	20540	MA
2	122300000X	Dentist	19996	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306874292	OTHER	MA	DENTIST
2	1578591475	OTHER	MA	DENTIST

General Provider Information

NPI Number	:	1699824433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3-D DENTAL, PC

Provider Business Mailing Address
First Line	:	411 MASSACHUSETTS AVE
Second Line	:	SUITE 204
City	:	ACTON
State	:	MA
Zip	:	01720-3739
Country	:	US
Telephone Number	:	978-266-1288
Fax Number	:	978-266-1230

Provider Business Practice Location Address
First Line	:	411 MASSACHUSETTS AVE
Second Line	:	SUITE 204
City	:	ACTON
State	:	MA
Zip	:	01720-3739
Country	:	US
Telephone Number	:	978-266-1288
Fax Number	:	978-266-1230

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID WEI WANG
Credential	:	DMD
Telephone Number	:	978-266-1288

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	05/16/2012

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