Healthcare Provider Details

I. General information

NPI: 1538256391
Provider Name (Legal Business Name): ALAN WONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 W 84TH AVE
FEDERAL HEIGHTS CO
80260-5044
US

IV. Provider business mailing address

1851 W 84TH AVE
FEDERAL HEIGHTS CO
80260-5044
US

V. Phone/Fax

Practice location:
  • Phone: 303-429-6411
  • Fax: 303-429-0118
Mailing address:
  • Phone: 303-429-6411
  • Fax: 303-429-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6940
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: