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General NPI Number Information
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NPI Number | 1386467512
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Entity Type | Organization
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Legal Business Name | GW DENTAL STUDIO PC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 20726 NORTHERN BLVD STE 2B
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City | BAYSIDE
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State | NY
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Zip | 11361-3147
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Country | US
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Telephone | 718-885-4323
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Fax | 718-885-4325
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Provider Business Mailing Address
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Address Line | 20726 NORTHERN BLVD STE 2B
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City | BAYSIDE
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State | NY
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Zip | 11361-3147
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Country | US
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Telephone | 718-885-4323
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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. GORDON WANG
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Credential | DDS
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Telephone | 646-703-4376
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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 |
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License Number State |
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