Provider Demographics
NPI:1851329189
Name:WANG, JEFFREY (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 CASCADE VALLEY CT
Mailing Address - Street 2:107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0496
Mailing Address - Country:US
Mailing Address - Phone:702-233-9988
Mailing Address - Fax:702-233-9012
Practice Address - Street 1:7151 CASCADE VALLEY CT
Practice Address - Street 2:107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0496
Practice Address - Country:US
Practice Address - Phone:702-233-9988
Practice Address - Fax:702-233-9012
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS4-531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics