Active NPI
Jeannie Jin Wang, DMD
- Endodontics
- Flower Mound, TX
National Provider Identifier
1912450578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 34592
- Practice address
- 4421 Long Prairie Rd.
#400
Flower Mound, TX 75028 - Phone
- (972) 691-3636
- NPI assigned
- Aug 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | RES3773 | OH | |
| Endodontics | 1223E0200X | 34592 | TX | Primary |
Addresses
Primary practice location
4421 Long Prairie Rd.
#400
Flower Mound, TX 75028
Mailing address
302 Walnut Grove LN.
Coppell, TX 75019
Phone (917) 403-6753
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 |
|---|---|---|---|
| 34592 | TX | MD | Endodontist |
| RES3773 | OH | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572912000000",
"number": "1912450578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 WALNUT GROVE LN.",
"city": "COPPELL",
"state": "TX",
"postal_code": "75019",
"telephone_number": "917-403-6753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4421 LONG PRAIRIE RD.",
"address_2": "#400",
"city": "FLOWER MOUND",
"state": "TX",
"postal_code": "75028",
"telephone_number": "972-691-3636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANG",
"first_name": "JEANNIE",
"middle_name": "JIN",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-01",
"last_updated": "2019-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "OH",
"license": "RES3773",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "TX",
"license": "34592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flower Mound, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.