Healthcare Provider Details

I. General information

NPI: 1649639261
Provider Name (Legal Business Name): PETER TONG DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COURTHOUSE SQ SUITE 105
ROCKVILLE MD
20850-2336
US

IV. Provider business mailing address

20 COURTHOUSE SQ SUITE 105
ROCKVILLE MD
20850-2336
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-8888
  • Fax: 301-424-8667
Mailing address:
  • Phone: 301-424-8888
  • Fax: 301-424-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number12540
License Number StateMD

VIII. Authorized Official

Name: DR. PETER TONG
Title or Position: PRESIDENT
Credential: DDS
Phone: 301-424-8888