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General NPI Number Information
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NPI Number | 1417202417
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Entity Type | Individual
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Provider Name | ESTEE P WANG DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1668 COPE AVE E
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2655
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Country | US
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Telephone | 651-777-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1668 COPE AVE E
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2655
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Country | US
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Telephone | 651-356-9249
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D13144
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License Number State | MN
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