Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 32301 | TX |
NPI | 1073068649 |
---|---|
Provider Name | Fengming Wang |
First Address | Dallas, TX 75246-2013 |
Second Address | Dallas, TX 75246-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2016 |
Last Update Date | 03/11/2016 |