Healthcare Provider Details

I. General information

NPI: 1730953530
Provider Name (Legal Business Name): WANG & MO DENTAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 PLEASANT HILL RD
PLEASANT HILL CA
94523-2036
US

IV. Provider business mailing address

427 CARL ST
SAN FRANCISCO CA
94117-3601
US

V. Phone/Fax

Practice location:
  • Phone: 925-947-1188
  • Fax:
Mailing address:
  • Phone: 404-452-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HELEN MO
Title or Position: OWNER
Credential: DMD, MS
Phone: 925-947-1188