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General NPI Number Information
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NPI Number | 1346772902
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Entity Type | Individual
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Provider Name | HAOMIAO WANG DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 10115 SW NIMBUS AVE STE 350
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City | PORTLAND
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State | OR
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Zip | 97223-4330
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Country | US
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Telephone | 503-308-6592
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 CLIFTON RD NE BUILDING B, SUITE 2300, ATLANTA,
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City | ATLANTA
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State | GA
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Zip | 30322-1013
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Country | US
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Telephone | 360-314-8368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 11818
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License Number State | OR
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