Provider Demographics
NPI:1639345879
Name:TIM WANG DDS, INC
Entity Type:Organization
Organization Name:TIM WANG DDS, INC
Other - Org Name:COLUMBIA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:TING- CHUN
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-792-7888
Mailing Address - Street 1:46921 WARM SPRINGS BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7934
Mailing Address - Country:US
Mailing Address - Phone:510-792-7888
Mailing Address - Fax:
Practice Address - Street 1:46921 WARM SPRINGS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7934
Practice Address - Country:US
Practice Address - Phone:510-792-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48405261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental