Basic Information
| Provider Information | |||||||||
| NPI: | 1447565239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | NIPING | ||||||||
| MiddleName: | |||||||||
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| Credential: | BDS, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4463 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392065306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015190557 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1090 NORTHCHASE PKWY SE | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300676405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789045665 | ||||||||
| FaxNumber: | 6782477862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2010 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 3664-12 | MS | Y | Dental Providers | Dentist |
No ID Information.