Provider Demographics
NPI:1477780534
Name:WING, JEFFREY L (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:WING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SUTTER ST RM 2203
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4207
Mailing Address - Country:US
Mailing Address - Phone:415-956-6050
Mailing Address - Fax:415-956-6134
Practice Address - Street 1:450 SUTTER ST RM 2203
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4207
Practice Address - Country:US
Practice Address - Phone:415-956-6050
Practice Address - Fax:415-956-6134
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist