Healthcare Provider Details

I. General information

NPI: 1124037247
Provider Name (Legal Business Name): SHU-HSIA WANG D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16037 COMPRINT CIR
GAITHERSBURG MD
20877-1320
US

IV. Provider business mailing address

951 FARM HAVEN DR
ROCKVILLE MD
20852-4248
US

V. Phone/Fax

Practice location:
  • Phone: 301-977-8383
  • Fax:
Mailing address:
  • Phone: 301-984-1985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8204
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6311
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: