Provider Demographics
NPI:1063191096
Name:CLINTONVILLE DENTISTRY
Entity type:Organization
Organization Name:CLINTONVILLE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HONGWEI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-262-8180
Mailing Address - Street 1:4490 INDIANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2244
Mailing Address - Country:US
Mailing Address - Phone:614-262-8180
Mailing Address - Fax:
Practice Address - Street 1:4490 INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2244
Practice Address - Country:US
Practice Address - Phone:614-262-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental