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General NPI Number Information
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NPI Number | 1053768861
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Entity Type | Organization
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Legal Business Name | PERFECT DENTAL
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Dates
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Enumeration Date | 05/21/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 500 BOLLINGER CANYON WAY #A-17
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City | SAN RAMON
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State | CA
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Zip | 94582-5251
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Country | US
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Telephone | 925-735-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 20735 STEVENS CREEK BLVD SUITE G
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City | CUPERTINO
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State | CA
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Zip | 95014-2162
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Country | US
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Telephone | 408-725-8300
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EDDY Y WANG
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Credential | D.M.D.
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Telephone | 310-622-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61981
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License Number State | CA
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