Provider Demographics
NPI:1780850164
Name:BENJAMIN H WANG D D S INC.
Entity Type:Organization
Organization Name:BENJAMIN H WANG D D S INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-968-3616
Mailing Address - Street 1:682 VILLA ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1375
Mailing Address - Country:US
Mailing Address - Phone:650-968-3616
Mailing Address - Fax:
Practice Address - Street 1:682 VILLA ST STE A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1375
Practice Address - Country:US
Practice Address - Phone:650-968-3616
Practice Address - Fax:650-968-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty