Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS037440 | PA |
NPI | 1013179167 |
---|---|
Provider Name | Dr. Vanessa Y. Wang |
First Address | Penn Valley, PA 19072-1212 |
Second Address | Narberth, PA 19072-1963 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 16/07/2020 |