Healthcare Provider Details

I. General information

NPI: 1740339605
Provider Name (Legal Business Name): AUSTIN H WANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 MANCHESTER ST SUITE 5
CONCORD NH
03301
US

IV. Provider business mailing address

153 MANCHESTER ST SUITE 5
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9474
  • Fax: 603-224-9232
Mailing address:
  • Phone: 603-224-9474
  • Fax: 603-224-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3289
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: