Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN25322 | FL |
NPI | 1023490026 |
---|---|
Provider Name | Dr. Dixin Wang |
First Address | Kissimmee, FL 34744-3603 |
Second Address | Kissimmee, FL 34744-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2015 |
Last Update Date | 09/02/2021 |