Provider Demographics
NPI:1053489088
Name:WANG, RICHARD KE MING (DMD MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KE MING
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S WHITING ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3418
Mailing Address - Country:US
Mailing Address - Phone:703-751-7841
Mailing Address - Fax:703-751-7858
Practice Address - Street 1:101 S WHITING ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3418
Practice Address - Country:US
Practice Address - Phone:703-751-7841
Practice Address - Fax:703-751-7858
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOMS49122300000X, 204E00000X
PADS030776L122300000X
VA04380002341223S0112X
VA04014118291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery