Healthcare Provider Details

I. General information

NPI: 1063558617
Provider Name (Legal Business Name): WALTER S. HONG, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MOUNTAIN RD
PASADENA MD
21122-4520
US

IV. Provider business mailing address

4330 MOUNTAIN RD
PASADENA MD
21122-4520
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-8001
  • Fax: 410-255-0687
Mailing address:
  • Phone: 410-255-8001
  • Fax: 410-255-0687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number13307
License Number StateMD

VIII. Authorized Official

Name: DR. WALTER S HONG
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 410-255-8001