Healthcare Provider Details

I. General information

NPI: 1235512906
Provider Name (Legal Business Name): HEATHER RENEE HONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER RENEE WONG DDS

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 01/10/2021
Certification Date: 01/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 S YOSEMITE ST
DENVER CO
80237
US

IV. Provider business mailing address

5994 S HOLLY ST # 140
GREENWOOD VILLAGE CO
80111-4221
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-0990
  • Fax:
Mailing address:
  • Phone: 626-823-9740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number61761
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2020031410
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDDS104922
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD11241
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number203420
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856936
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: