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Organization
WEN TA FAN DDS PC
Active
Organization
WEN TA FAN DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WEN TA FAN DDS (PRESIDENT)
(715) 539-9130
Entity
Organization
Contact information
Practice address
4231 COLDEN ST STE 204, FLUSHING, NY 11355-3981
(718) 539-9130
(718) 539-9180
Mailing address
4231 COLDEN ST STE 204, FLUSHING, NY 11355-3981
(718) 539-9130
(718) 539-9180
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
047296
NY
Other
Enumeration date
07/18/2006
Last updated
08/22/2020
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