Provider Demographics
NPI:1790367100
Name:MICHAEL R. WANG, DDS, INC.
Entity Type:Organization
Organization Name:MICHAEL R. WANG, DDS, INC.
Other - Org Name:MISSION PEAK PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-980-7325
Mailing Address - Street 1:43480 MISSION BLVD UNIT 160
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5892
Mailing Address - Country:US
Mailing Address - Phone:510-980-7325
Mailing Address - Fax:510-980-7328
Practice Address - Street 1:43480 MISSION BLVD UNIT 160
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5892
Practice Address - Country:US
Practice Address - Phone:510-980-7325
Practice Address - Fax:510-980-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental