Healthcare Provider Details

I. General information

NPI: 1194750059
Provider Name (Legal Business Name): LEI WANG D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CONGRESSIONAL LN STE 605
ROCKVILLE MD
20852-1562
US

IV. Provider business mailing address

121 CONGRESSIONAL LN STE 605
ROCKVILLE MD
20852-1562
US

V. Phone/Fax

Practice location:
  • Phone: 301-984-2200
  • Fax:
Mailing address:
  • Phone: 301-984-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13636
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13636
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: