=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750572970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XIN JENNY WANG, D.M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 08/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 WINN ST SUITE 206
-----------------------------------------------------
City | WOBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-933-5023
-----------------------------------------------------
Fax | 781-207-4678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 WINN ST SUITE 206
-----------------------------------------------------
City | WOBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01801-2897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-933-5023
-----------------------------------------------------
Fax | 781-207-4678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR./DENTIST /OWNER
-----------------------------------------------------
Name | DR. XIN JENNY WANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 781-933-5023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 20553
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------