# WEN TA FAN DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972521888
- **Authorized official:** DR. WEN TA FAN DDS (PRESIDENT)
- **Authorized official phone:** (715) 539-9130

## Contact information

- **Practice address:** 4231 COLDEN ST STE 204, FLUSHING, NY 11355-3981
- **Practice address phone:** (718) 539-9130
- **Practice address fax:** (718) 539-9180
- **Mailing address:** 4231 COLDEN ST STE 204, FLUSHING, NY 11355-3981
- **Mailing address phone:** (718) 539-9130
- **Mailing address fax:** (718) 539-9180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 047296 | NY | Yes |

## Other

- **Enumeration date:** 07/18/2006
- **Last updated:** 08/22/2020