MEDICARE: CHRISTINA WEI-JING 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	1223G0001X	General Practice Dentistry	DN 19790	FL

General Provider Information

NPI Number	:	1942563325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA WEI-JING WANG DMD

Provider Business Mailing Address
First Line	:	9531 SEAGRAPE DR
Second Line	:	#307
City	:	DAVIE
State	:	FL
Zip	:	33324-5979
Country	:	US
Telephone Number	:	408-835-2746
Fax Number	:

Provider Business Practice Location Address
First Line	:	2482 SW 27TH TER
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-3119
Country	:	US
Telephone Number	:	305-859-7949
Fax Number	:

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

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	06/20/2012

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