Elayne Wang, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

123413 Issued in GA

Practice address

4429 Washington Rd
Evans, GA 30809-6370

Phone

(706) 395-9031

NPI assigned

May 11, 2023

Last updated

Jul 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emerald Dental, LLC

  • General Practice Dentistry
  • Evans, GA
  • NPI 1568377455
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720224000000",
    "number": "1952091969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 N BIG CYPRESS DR APT 450",
            "city": "ST JOHNS",
            "state": "FL",
            "postal_code": "322591966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4429 WASHINGTON RD",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308096370",
            "telephone_number": "706-395-9031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4873 Belle Terre Pkwy",
            "address_purpose": "LOCATION",
            "city": "Palm Coast",
            "state": "FL",
            "postal_code": "321378696",
            "country_code": "US",
            "telephone_number": "386-777-7445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "ELAYNE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-11",
        "last_updated": "2024-07-06",
        "certification_date": "2024-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "123413",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "27971",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystal Ann Wall, FNP-C
• Brett Wallentine, MD
• Adam David Waller, M.D.
• Amy Walsh
• Alexander Dominique Walters
• Lisa Marie Wannamaker, D.O.
• Jennifer Ward, D.O.
• Stephen Paul Warren, NP-C
• Teresa Annette Watts, DNP, FNP-C
• Adrian Todd Weaver, D.M.D.

• Dentist in Evans, GA
• Providers in Evans, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.