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General NPI Number Information
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NPI Number | 1255567053
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Entity Type | Organization
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Legal Business Name | LAWRENCE WANG
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 1158 BROADWAY 3RD FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-7506
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Country | US
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Telephone | 917-584-0824
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 65TH ST
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City | BROOKLYN
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State | NY
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Zip | 11204-4035
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Country | US
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Telephone | 917-584-0824
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Fax |
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Authorized Official
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Title or Position | OWNER/DDS
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Name | DR. LAWRENCE Y WANG
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Credential | DDS
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Telephone | 917-584-0824
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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 | 052336
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License Number State | NY
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