Provider Demographics
NPI:1144062001
Name:GREGORY G. WANG, DDS, PLLC
Entity type:Organization
Organization Name:GREGORY G. WANG, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-450-0731
Mailing Address - Street 1:12909 NE 201ST ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-3702
Mailing Address - Country:US
Mailing Address - Phone:646-450-0731
Mailing Address - Fax:
Practice Address - Street 1:22010 17TH AVE SE STE B
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8486
Practice Address - Country:US
Practice Address - Phone:425-481-8571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental