Shunbao Wang

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401420257 Issued in VA

Practice address

10751 Ambassador Dr Ste 101
Manassas, VA 20109-2525

Phone

(808) 382-2568

NPI assigned

Jul 3, 2023

Last updated

Oct 15, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792022400000",
    "number": "1760169429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 MARYLAND DR",
            "address_2": "STE S",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23294",
            "telephone_number": "212-998-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10751 AMBASSADOR DR STE 101",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092525",
            "telephone_number": "808-382-2568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5130 Duke St Ste 4",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223042955",
            "country_code": "US",
            "telephone_number": "703-370-6500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "SHUNBAO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-03",
        "last_updated": "2026-10-15",
        "certification_date": "2026-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401420257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Douglas Wall, M. D.
• Ashleigh Marie Wallace, NURSE PRACTITIONER
• Mary Walters
• Guy Benjamin Wampler, MD
• Julie Yujie Wang, D.O.
• Tien Wang
• Gretchen Renee Ward, M.S., OTR/L
• Jamie Christine Ward, LPC
• Annie Ware, DMD
• Tiffany Ware

• General Practice Dentistry in Manassas, VA
• Providers in Manassas, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.