Individual
STEPHANIE FANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
339 SQUIRE RD STE 150, REVERE, MA 02151-4396
(781) 286-7510
Mailing address
345 E 24TH ST, NEW YORK, NY 10010-4020
(212) 998-9800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN10000454
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/05/2023
Last updated
08/14/2024
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