Healthcare Provider Details

I. General information

NPI: 1346777208
Provider Name (Legal Business Name): VICTOR YING WANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MONTVALE AVE STE 101
STONEHAM MA
02180-3618
US

IV. Provider business mailing address

169 MONSIGNOR OBRIEN HWY APT 705
CAMBRIDGE MA
02141-1261
US

V. Phone/Fax

Practice location:
  • Phone: 781-279-2400
  • Fax:
Mailing address:
  • Phone: 781-460-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02864600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number12534
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN1859441
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: