Healthcare Provider Details

I. General information

NPI: 1346772902
Provider Name (Legal Business Name): HAOMIAO WANG DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEVEN WANG DMD, MD

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10115 SW NIMBUS AVE STE 350
PORTLAND OR
97223-4330
US

IV. Provider business mailing address

1365 CLIFTON RD NE BUILDING B, SUITE 2300, ATLANTA,
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 503-308-6592
  • Fax:
Mailing address:
  • Phone: 360-314-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11818
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: