Provider Demographics
NPI:1386061869
Name:QIANMIN WANG DDS,INC
Entity type:Organization
Organization Name:QIANMIN WANG DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QIANMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-861-0928
Mailing Address - Street 1:1129 W 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4477
Mailing Address - Country:US
Mailing Address - Phone:559-395-4337
Mailing Address - Fax:559-395-4602
Practice Address - Street 1:1129 W 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4477
Practice Address - Country:US
Practice Address - Phone:559-395-4337
Practice Address - Fax:559-395-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty