Provider Demographics
NPI:1386139020
Name:WANG, JOANNA YIN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:YIN
Last Name:WANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 YARMOUTH PL APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5870
Mailing Address - Country:US
Mailing Address - Phone:301-768-3578
Mailing Address - Fax:
Practice Address - Street 1:314 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1411
Practice Address - Country:US
Practice Address - Phone:978-327-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18580281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice