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General NPI Number Information
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NPI Number | 1447522545
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Entity Type | Individual
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Provider Name | JEFFREY MATTHEW WANG DDS
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Gender | Male
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Dates
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Enumeration Date | 02/04/2012
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 25285 MADISON AVE #107
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City | MURRIETA
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State | CA
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Zip | 92562
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Country | US
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Telephone | 951-698-3585
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Fax |
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Provider Business Mailing Address
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Address Line | 14138 POPPY VIEW CT
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City | EASTVALE
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State | CA
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Zip | 92880-9034
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Country | US
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Telephone | 818-679-0336
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 61155
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 32522
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD3724
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 27684
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61155
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License Number State | CA
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