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General NPI Number Information
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NPI Number | 1679139877
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Entity Type | Individual
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Provider Name | BENJAMIN WANG DDS
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Gender | Male
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 2050A 2ND ST SE
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-5522
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Country | US
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Telephone | 505-846-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WILFORD HALL LOOP BLDG 4554
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-5638
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Country | US
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Telephone | 210-292-0755
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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 | DD5691
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35487
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License Number State | TX
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