MEDICARE: DR. VICTOR YING WANG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	22DI02864600	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program	12534	CT
3	1223P0221X	Pediatric Dentistry	DN1859441	MA

General Provider Information

NPI Number	:	1346777208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR YING WANG DMD

Provider Business Mailing Address
First Line	:	169 MONSIGNOR OBRIEN HWY APT 705
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02141-1261
Country	:	US
Telephone Number	:	781-460-3815
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 MONTVALE AVE STE 101
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3618
Country	:	US
Telephone Number	:	781-279-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	09/10/2024

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