| Blake Wang Dmd Pc | |
|
2067 Ygnacio Valley Rd Walnut Creek CA 94598-3301 | |
| (925) 934-1211 | |
| Not Available |
| Full Name | Blake Wang Dmd Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2067 Ygnacio Valley Rd, Walnut Creek, California |
| Authorized Official Name and Position | Blake Yuanxing Wang (OWNER) |
| Authorized Official Contact | 7813256621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blake Wang Dmd Pc 3725 First St Livermore CA 94551-4905 Ph: (781) 325-6621 | Blake Wang Dmd Pc 2067 Ygnacio Valley Rd Walnut Creek CA 94598-3301 Ph: (925) 934-1211 |
| NPI Number | 1174121354 |
|---|---|
| Provider Enumeration Date | 10/11/2020 |
| Last Update Date | 10/11/2020 |
| Medicare PECOS PAC ID | 7618365982 |
|---|---|
| Medicare Enrollment ID | O20211020000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174121354 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Blake Yuanxing Wang |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1811507544 PECOS PAC ID: 6800284175 Enrollment ID: I20211020000310 |
| Provider Name | Xiaorong Chen |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1558383034 PECOS PAC ID: 3072901503 Enrollment ID: I20211102001512 |
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