Provider Demographics
NPI:1861597270
Name:NG, WAI-KWAN (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:WAI-KWAN
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:VERONICA WAI-KWAN
Other - Middle Name:
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MSD
Mailing Address - Street 1:48606 HILLTOP DR W
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5260
Mailing Address - Country:US
Mailing Address - Phone:734-416-4289
Mailing Address - Fax:734-416-4289
Practice Address - Street 1:120 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4104
Practice Address - Country:US
Practice Address - Phone:734-242-0745
Practice Address - Fax:734-242-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010169471223G0001X, 1223P0300X
OH300199321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0300XDental ProvidersDentistPeriodontics