Provider Demographics
NPI:1174192314
Name:PATRICK WANG DDS MD PLLC
Entity Type:Organization
Organization Name:PATRICK WANG DDS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:214-215-4913
Mailing Address - Street 1:14235 SE 92ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3460
Mailing Address - Country:US
Mailing Address - Phone:214-215-4913
Mailing Address - Fax:
Practice Address - Street 1:14235 SE 92ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3460
Practice Address - Country:US
Practice Address - Phone:214-215-4913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty