Healthcare Provider Details

I. General information

NPI: 1104201474
Provider Name (Legal Business Name): CHARLES WANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 CRAIN HWY S STE 103
GLEN BURNIE MD
21061-5631
US

IV. Provider business mailing address

7201 ALDEN WAY UNIT 3042
HANOVER MD
21076-2482
US

V. Phone/Fax

Practice location:
  • Phone: 323-287-6840
  • Fax:
Mailing address:
  • Phone: 323-287-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10151
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18220
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: