Healthcare Provider Details

I. General information

NPI: 1972915429
Provider Name (Legal Business Name): ANGELA WANG D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 11/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 OGDEN AVENUE SUITE 104
AURORA IL
60504
US

IV. Provider business mailing address

2124 OGDEN AVENUE SUITE 104
AURORA IL
60504
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-6100
  • Fax: 630-778-2070
Mailing address:
  • Phone: 630-585-6100
  • Fax: 630-778-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number021.002834
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: