Provider Demographics
NPI:1174616114
Name:WANG, XIAOJUN (DDS)
Entity type:Individual
Prefix:DR
First Name:XIAOJUN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 GARRETT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3487
Mailing Address - Country:US
Mailing Address - Phone:919-489-8820
Mailing Address - Fax:919-489-8825
Practice Address - Street 1:4300 GARRETT RD
Practice Address - Street 2:SUITE D
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3487
Practice Address - Country:US
Practice Address - Phone:919-489-8820
Practice Address - Fax:919-489-8825
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice