Provider Demographics
NPI:1487867198
Name:WANG, GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:WANG
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 1:817 W PIONEER PKWY
Mailing Address - Street 2:#150
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4710
Mailing Address - Country:US
Mailing Address - Phone:972-602-2000
Mailing Address - Fax:972-602-2062
Practice Address - Street 1:817 W PIONEER PKWY
Practice Address - Street 2:#150
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4710
Practice Address - Country:US
Practice Address - Phone:972-602-2000
Practice Address - Fax:972-602-2062
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist