Provider Demographics
NPI:1588352728
Name:WANG, MANQI (DDS, PHD)
Entity type:Individual
Prefix:
First Name:MANQI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 VETERANS MEMORIAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5122
Mailing Address - Country:US
Mailing Address - Phone:504-273-7156
Mailing Address - Fax:
Practice Address - Street 1:2937 VETERANS MEMORIAL BLVD STE C
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6067
Practice Address - Country:US
Practice Address - Phone:504-470-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA74541223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program