Healthcare Provider Details

I. General information

NPI: 1851329189
Provider Name (Legal Business Name): JEFFREY WANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7151 CASCADE VALLEY CT 107
LAS VEGAS NV
89128-0496
US

IV. Provider business mailing address

7151 CASCADE VALLEY CT 107
LAS VEGAS NV
89128-0496
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-9988
  • Fax: 702-233-9012
Mailing address:
  • Phone: 702-233-9988
  • Fax: 702-233-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4-53
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: