Provider Demographics
NPI:1447522545
Name:WANG, JEFFREY MATTHEW (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MATTHEW
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 1:14138 POPPY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9034
Mailing Address - Country:US
Mailing Address - Phone:818-679-0336
Mailing Address - Fax:
Practice Address - Street 1:25285 MADISON AVE #107
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-698-3585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-04
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61155122300000X, 1223G0001X
TX325221223G0001X
NMDD37241223G0001X
TX276841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist