Provider Demographics
NPI:1750558466
Name:WANG, BENJAMIN H (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:H
Last Name:WANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 VILLA ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1375
Mailing Address - Country:US
Mailing Address - Phone:650-968-3616
Mailing Address - Fax:650-968-1728
Practice Address - Street 1:682 VILLA ST STE A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1375
Practice Address - Country:US
Practice Address - Phone:650-968-3616
Practice Address - Fax:650-968-1728
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist