Individual
CHRISTINE WANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
10 S LARKIN AVE, JOLIET, IL 60436-1243
(312) 274-0308
Mailing address
10 S LARKIN AVE, JOLIET, IL 60436-1243
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028748
IL
122300000X
Dentist
22DI02453700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154592145
DENTAL DREAMS LLC
IL
Enumeration date
10/15/2010
Last updated
12/21/2012
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