Individual
ELI VANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2719 CALUMET AVE, MANITOWOC, WI 54220-5546
(920) 783-6633
Mailing address
PO BOX 959, SHEBOYGAN, WI 53082-0959
(920) 783-6633
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6001027-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6001027-15
WI STATE LICENSE
WI
Enumeration date
07/27/2022
Last updated
07/27/2022
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