Provider Demographics
NPI:1457767048
Name:WEIDONG WANG D. D. S. CORP
Entity Type:Organization
Organization Name:WEIDONG WANG D. D. S. CORP
Other - Org Name:A NEW IMAGE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WEIDONG
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:831-392-1000
Mailing Address - Street 1:1165 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5741
Mailing Address - Country:US
Mailing Address - Phone:831-392-1000
Mailing Address - Fax:831-392-1010
Practice Address - Street 1:1165 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5741
Practice Address - Country:US
Practice Address - Phone:831-392-1000
Practice Address - Fax:831-392-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization