WEN TA FAN DDS PC NPI 1972521888

NPI Information

NPI: 1972521888
Provider Name: WEN TA FAN DDS PC
Classification: Clinic/Center - 261QD0000X
Specialization: Dental
Entity Type: Organization
Address: 4231 COLDEN ST STE 204
FLUSHING, NY
ZIP 11355
Phone: (718) 539-9130

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NPI Details

WEN TA FAN DDS PC is a dental clinic center in Flushing, NY. WEN TA FAN DDS PC NPI is 1972521888. The provider is registered as an organization entity type.

The provider's business location address is:

4231 COLDEN ST STE 204
FLUSHING, NY
ZIP 11355-981
Phone: (718) 539-9130
Fax: (718) 539-9180

The provider's authorized official is Wen Ta Fan .
The authorized official title is President and has the following contact phone number (715) 539-9130.

The enumeration date for this NPI number is 7/18/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	047296	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	02756412	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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