Healthcare Provider Details

I. General information

NPI: 1467107011
Provider Name (Legal Business Name): MARISSA WANG DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2022
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1763 UNION ST
SAN FRANCISCO CA
94123-4406
US

IV. Provider business mailing address

2261 MARKET ST # 4502
SAN FRANCISCO CA
94114-1612
US

V. Phone/Fax

Practice location:
  • Phone: 415-440-9000
  • Fax:
Mailing address:
  • Phone: 626-297-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARISSA WANG
Title or Position: DENTIST
Credential: DMD
Phone: 415-440-9000