Provider Demographics
NPI:1750646865
Name:VICKI H. WANG DENTAL CORPORATION
Entity Type:Organization
Organization Name:VICKI H. WANG DENTAL CORPORATION
Other - Org Name:SMILE NOW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:HYUNA
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-797-3451
Mailing Address - Street 1:1282 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2854
Mailing Address - Country:US
Mailing Address - Phone:626-797-3451
Mailing Address - Fax:626-797-3431
Practice Address - Street 1:1282 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2854
Practice Address - Country:US
Practice Address - Phone:626-797-3451
Practice Address - Fax:626-797-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47206261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1064883749OtherINDIVIDUAL NPI