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NPI Code Detail

MEDICARE: JUSTIN WANG DMD, MD

MEDICARE: JUSTIN WANG DMD, MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)00205465CO

General Provider Information

NPI Number : 1316446198
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN WANG DMD, MD
Provider Business Mailing Address
First Line : 5392 S WADSWORTH BLVD UNIT 103
Second Line :
City : LAKEWOOD
State : CO
Zip : 80123-1271
Country : US
Telephone Number : 303-979-4277
Fax Number :
Provider Business Practice Location Address
First Line : 5392 S WADSWORTH BLVD UNIT 103
Second Line :
City : LAKEWOOD
State : CO
Zip : 80123-1271
Country : US
Telephone Number : 303-979-4277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2018
Last Update Date : 05/30/2023

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Directions to “ JUSTIN WANG DMD, MD” Practice Location

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