Healthcare Provider Details

I. General information

NPI: 1568045805
Provider Name (Legal Business Name): CATHY KWONG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE SHORE DR STE 112
ALTAMONTE SPRINGS FL
32714-5012
US

IV. Provider business mailing address

100 LAKE SHORE DR STE 112
ALTAMONTE SPRINGS FL
32714-5012
US

V. Phone/Fax

Practice location:
  • Phone: 407-869-0001
  • Fax:
Mailing address:
  • Phone: 401-869-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1860049
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN25556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: