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General NPI Number Information
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NPI Number | 1003982257
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Entity Type | Individual
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Provider Name | WEI GAO DDS
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 318 COLLEGE AVE
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City | ROCKFORD
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State | IL
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Zip | 61104-2922
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Country | US
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Telephone | 815-965-5555
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Fax | 815-965-5561
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Provider Business Mailing Address
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Address Line | 318 COLLEGE AVE
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City | ROCKFORD
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State | IL
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Zip | 61104-2922
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Country | US
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Telephone | 815-655-5555
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Fax | 815-965-5561
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019026335
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License Number State | IL
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