Provider Demographics
NPI:1962720623
Name:WANG, BO (DDS, MD)
Entity type:Individual
Prefix:
First Name:BO
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
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Mailing Address - Street 1:281 WITHERSPOON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3228
Mailing Address - Country:US
Mailing Address - Phone:609-288-2855
Mailing Address - Fax:
Practice Address - Street 1:281 WITHERSPOON ST STE 210
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3228
Practice Address - Country:US
Practice Address - Phone:609-288-2855
Practice Address - Fax:609-800-8500
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ22DI02634500204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty