Provider Demographics
NPI:1144388430
Name:WANG, WEIDONG (DDS)
Entity type:Individual
Prefix:DR
First Name:WEIDONG
Middle Name:
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 1:1240 CAMPANIA WAY
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-4904
Mailing Address - Country:US
Mailing Address - Phone:831-676-6332
Mailing Address - Fax:831-757-3287
Practice Address - Street 1:1165 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5741
Practice Address - Country:US
Practice Address - Phone:831-392-1000
Practice Address - Fax:831-392-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS544001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18217Medicare ID - Type Unspecified