Healthcare Provider Details

I. General information

NPI: 1598029142
Provider Name (Legal Business Name): XIANG WANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 01/21/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BAY ST
STATEN ISLAND NY
10301-2510
US

IV. Provider business mailing address

57 BAY ST
STATEN ISLAND NY
10301-2510
US

V. Phone/Fax

Practice location:
  • Phone: 855-681-8700
  • Fax:
Mailing address:
  • Phone: 855-681-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number062748
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: