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General NPI Number Information
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NPI Number | 1689105744
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Entity Type | Organization
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Legal Business Name | WANG FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 2424 W INDIAN TRL STE D
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City | AURORA
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State | IL
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Zip | 60506-1588
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Country | US
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Telephone | 630-907-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 5712 ROSINWEED LN
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City | NAPERVILLE
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State | IL
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Zip | 60564-1642
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Country | US
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Telephone | 630-989-6868
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE WANG
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Credential | DMD
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Telephone | 630-989-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028748
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License Number State | IL
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