Provider Demographics
NPI:1588892186
Name:WANG, ALICE C (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:C
Last Name:WANG
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9631 ATHENS PL
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5382
Mailing Address - Country:US
Mailing Address - Phone:301-541-8895
Mailing Address - Fax:
Practice Address - Street 1:5900 WATERLOO RD
Practice Address - Street 2:#220
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2630
Practice Address - Country:US
Practice Address - Phone:301-541-8895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014139761223X0400X
MD154191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics