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General NPI Number Information
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NPI Number | 1477314250
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Entity Type | Organization
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Legal Business Name | MARK D WANG DMD INC.
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 1309 N GRAND AVE
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City | WALNUT
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State | CA
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Zip | 91789-1317
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Country | US
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Telephone | 909-594-7899
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 N GRAND AVE
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City | WALNUT
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State | CA
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Zip | 91789-1317
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK WANG
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Credential |
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Telephone | 909-859-4424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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