Provider Demographics
NPI:1326254038
Name:WANG, PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:444 RAMSAY WAY
Mailing Address - Street 2:STE 109
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4536
Mailing Address - Country:US
Mailing Address - Phone:253-638-6046
Mailing Address - Fax:
Practice Address - Street 1:21105 SR 410 E STE G4
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8457
Practice Address - Country:US
Practice Address - Phone:253-299-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602732681223S0112X
WAMD60287538204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery