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General NPI Number Information
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NPI Number | 1376856633
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Entity Type | Individual
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Provider Name | JING WANG
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 3608 PAYNE AVENUE SUITE 101
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City | CLEVELAND
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State | OH
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Zip | 44114
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Country | US
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Telephone | 216-682-5676
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Fax |
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Provider Business Mailing Address
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Address Line | 3608 PAYNE AVE SUITE 101
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City | CLEVELAND
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State | OH
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Zip | 44114-4357
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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 |
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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 | 30-023662
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License Number State | OH
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