Healthcare Provider Details

I. General information

NPI: 1437030434
Provider Name (Legal Business Name): TING WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

5391 MAHOGANY DR
NOBLESVILLE IN
46062-1209
US

V. Phone/Fax

Practice location:
  • Phone: 463-248-9286
  • Fax:
Mailing address:
  • Phone: 463-248-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901602727
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: