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General NPI Number Information
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NPI Number | 1205453149
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Entity Type | Organization
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Legal Business Name | CHUANDI WANG PEDIATRIC DENTISTRY PC
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 5907 OAKLAND DR
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City | PORTAGE
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State | MI
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Zip | 49024-1120
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Country | US
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Telephone | 269-327-4459
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Fax |
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Provider Business Mailing Address
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Address Line | 5907 OAKLAND DR
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City | PORTAGE
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State | MI
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Zip | 49024-1120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | CHUANDI WANG
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Credential |
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Telephone | 269-267-5876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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