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General NPI Number Information
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NPI Number | 1164088860
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Entity Type | Organization
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Legal Business Name | MOWA LLC
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 05/17/2019
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Provider Practice Location Address
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Address Line | 9411 59TH AVE STE A5
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City | ELMHURST
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State | NY
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Zip | 11373-5158
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Country | US
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Telephone | 718-924-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 3626 215TH PL
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City | BAYSIDE
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State | NY
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Zip | 11361-2209
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Country | US
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Telephone | 917-833-2063
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MORLEY WANG
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Credential | DDS
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Telephone | 917-833-2063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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