Healthcare Provider Details

I. General information

NPI: 1386401750
Provider Name (Legal Business Name): PETER ONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654 GRAVOIS AVE
SAINT LOUIS MO
63116-4728
US

IV. Provider business mailing address

2102 OAK LEAF CIR
MOUNT DORA FL
32757-9679
US

V. Phone/Fax

Practice location:
  • Phone: 617-304-7558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2025014259
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044901
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: