Provider Demographics
NPI:1346772902
Name:WANG, HAOMIAO (DMD, MD)
Entity Type:Individual
Prefix:
First Name:HAOMIAO
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MD
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:BUILDING B, SUITE 2300, ATLANTA,
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:360-314-8368
Mailing Address - Fax:
Practice Address - Street 1:10115 SW NIMBUS AVE STE 350
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4330
Practice Address - Country:US
Practice Address - Phone:503-308-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR118181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty