Provider Demographics
NPI:1386815538
Name:WANG, ROBERT S (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:260 E ONTARIO AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3507
Mailing Address - Country:US
Mailing Address - Phone:951-898-9966
Mailing Address - Fax:928-833-9966
Practice Address - Street 1:260 E ONTARIO AVE STE 203
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3507
Practice Address - Country:US
Practice Address - Phone:951-898-9966
Practice Address - Fax:928-833-9966
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry