Provider Demographics
NPI:1386620979
Name:WANG, JOAO (DMD)
Entity type:Individual
Prefix:
First Name:JOAO
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 WORCESTER RD
Mailing Address - Street 2:APT. 335 A
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5449
Mailing Address - Country:US
Mailing Address - Phone:774-810-0654
Mailing Address - Fax:
Practice Address - Street 1:235 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7592
Practice Address - Country:US
Practice Address - Phone:508-628-9888
Practice Address - Fax:508-628-9777
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist