Provider Demographics
NPI:1043760978
Name:RAYMOND WANG DDS DENTAL CORP
Entity Type:Organization
Organization Name:RAYMOND WANG DDS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-925-3765
Mailing Address - Street 1:10318 E. ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-2702
Mailing Address - Country:US
Mailing Address - Phone:562-925-3765
Mailing Address - Fax:562-920-8500
Practice Address - Street 1:10318 E. ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-2702
Practice Address - Country:US
Practice Address - Phone:562-925-3765
Practice Address - Fax:562-920-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty