Provider Demographics
NPI:1689736605
Name:WANG, CHENG JER (DDS)
Entity Type:Individual
Prefix:MR
First Name:CHENG JER
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 1:500 E OLIVE AVE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2132
Mailing Address - Country:US
Mailing Address - Phone:818-841-2919
Mailing Address - Fax:818-841-2919
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:SUITE 620
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2132
Practice Address - Country:US
Practice Address - Phone:818-841-2919
Practice Address - Fax:818-841-2919
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist