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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02756412
—
NY
Enumeration date
07/18/2006
Last updated
08/22/2020
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