Provider Demographics
NPI:1487051736
Name:WANG, VICTOR (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
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 1:163 WASHINGTON VALLEY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7180
Mailing Address - Country:US
Mailing Address - Phone:732-560-5988
Mailing Address - Fax:732-563-6999
Practice Address - Street 1:163 WASHINGTON VALLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7180
Practice Address - Country:US
Practice Address - Phone:732-560-5988
Practice Address - Fax:732-563-6999
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO18523001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice