Healthcare Provider Details

I. General information

NPI: 1023664935
Provider Name (Legal Business Name): ESTEE WANG, DMD MS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 COPE AVE E
MAPLEWOOD MN
55109-2689
US

IV. Provider business mailing address

4535 HODGSON RD STE 700
SHOREVIEW MN
55126-1955
US

V. Phone/Fax

Practice location:
  • Phone: 651-777-7300
  • Fax:
Mailing address:
  • Phone: 651-765-1945
  • Fax: 651-765-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ESTEE WANG
Title or Position: OWNER
Credential: DMD MS
Phone: 651-765-1945