Healthcare Provider Details

I. General information

NPI: 1245770544
Provider Name (Legal Business Name): PEI WANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/17/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 LAKE MANASSAS DR STE 203
GAINESVILLE VA
20155-3259
US

IV. Provider business mailing address

4107 N RANDOLPH ST
ARLINGTON VA
22207-4813
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-4901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number102988
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401418098
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: