BLAKE WANG DMD PC
NPI 1174121354
Clinic/Center - Dental in Walnut Creek, CA
About Blake Wang Dmd Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLAKE WANG DMD PC (NPI 1174121354) is a healthcare organization registered as a dental in Walnut Creek, California and active in the NPI registry since October 2020. The organization lists Blake Yuanxing Wang, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Blake Wang Dmd Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Blake Wang Dmd PC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Blake Wang Dmd PC's NPI number?
The NPI number for Blake Wang Dmd PC is 1174121354. It was assigned to this organization in the NPPES registry on October 11, 2020.
Where is Blake Wang Dmd PC located?
Blake Wang Dmd PC is located at 2067 Ygnacio Valley Rd, Walnut Creek, CA 94598. The listed phone number is (925) 934-1211.
What is Blake Wang Dmd PC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.
Is Blake Wang Dmd PC enrolled in Medicare?
Yes. Blake Wang Dmd PC is registered in the Medicare PECOS enrollment system.
When is Blake Wang Dmd PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Blake Wang Dmd PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Blake Wang Dmd PC, in Dentist and Oral Surgery. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Blake Wang Dmd PC was last updated on October 11, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Blake Wang Dmd Pc · NPI 1174121354
Dental organization in Walnut Creek, California. Organization record, active in the CMS NPPES registry since October 11, 2020.
## Identity
- **NPI:** 1174121354 (Entity type: Organization)
- **Enumerated:** October 11, 2020
- **Primary specialty:** Clinic/Center - Dental · taxonomy 261QD0000X
- **Organization subpart:** No
- **Authorized official:** Blake Wang, OWNER
## Practice location
- **Address:** 2067 YGNACIO VALLEY RD, Walnut Creek, CA 94598-3301
- **Phone:** (925) 934-1211
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, California, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dentist (1), Oral Surgery (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 11, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1174121354) · Data from the CMS NPPES public registry.