Provider Demographics
NPI:1174723464
Name:WANG, ERNEST L (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:L
Last Name:WANG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 ROUTE 70
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4022
Mailing Address - Country:US
Mailing Address - Phone:732-477-0080
Mailing Address - Fax:732-477-3926
Practice Address - Street 1:525 ROUTE 70
Practice Address - Street 2:SUITE 1-D
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4022
Practice Address - Country:US
Practice Address - Phone:732-477-0080
Practice Address - Fax:732-477-3926
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023457001223X0400X
NY0533971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics