Provider Demographics
NPI:1215146774
Name:NG, WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2128
Mailing Address - Country:US
Mailing Address - Phone:773-465-8901
Mailing Address - Fax:847-324-9476
Practice Address - Street 1:2054 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2128
Practice Address - Country:US
Practice Address - Phone:773-465-8901
Practice Address - Fax:847-324-9476
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319010921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist