Active NPI
Andrew J Wang, DDS
- Dentist
- Olympia Fields, IL
National Provider Identifier
1790904290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019026153
- Practice address
- 3612 Lincoln Hwy Ste 18
Olympia Fields, IL 60461-1637 - Phone
- (708) 747-1430
- Fax
- (708) 747-9426
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019026153 | IL | Primary |
Addresses
Primary practice location
3612 Lincoln Hwy Ste 18
Olympia Fields, IL 60461-1637
Mailing address
3612 Lincoln Hwy Ste 18
Olympia Fields, IL 60461-1637
Phone (708) 747-1430
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019026153 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summerset Dental Care | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Olympia Fields, IL
- NPI 1407905169
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216944000000",
"number": "1790904290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3612 LINCOLN HWY STE 18",
"city": "OLYMPIA FIELDS",
"state": "IL",
"postal_code": "604611637",
"telephone_number": "708-747-1430",
"fax_number": "708-747-9426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3612 LINCOLN HWY STE 18",
"city": "OLYMPIA FIELDS",
"state": "IL",
"postal_code": "604611637",
"telephone_number": "708-747-1430",
"fax_number": "708-747-9426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANG",
"first_name": "ANDREW",
"middle_name": "J",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2008-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019026153",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia Fields, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.