Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 32868 | TX |
NPI | 1578086823 |
---|---|
Provider Name | Dr. Fan Wang |
First Address | Houston, TX 77072-1645 |
Second Address | Houston, TX 77072-1645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2017 |
Last Update Date | 19/07/2017 |