Healthcare Provider Details

I. General information

NPI: 1053390989
Provider Name (Legal Business Name): WONG & SMOLNICKY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E 86TH AVE
MERRILLVILLE IN
46410-6211
US

IV. Provider business mailing address

408 E 86TH AVE
MERRILLVILLE IN
46410-6211
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-8788
  • Fax: 219-923-8873
Mailing address:
  • Phone: 219-769-8788
  • Fax: 219-923-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008742
License Number StateIN

VIII. Authorized Official

Name: DR. CATHERINE M. WONG
Title or Position: VICE PRESIDENT & CO OWNER
Credential: D. D. S.
Phone: 219-769-8788