Healthcare Provider Details

I. General information

NPI: 1710486865
Provider Name (Legal Business Name): CHLOE A WONG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 BEECHER XING N STE C
GAHANNA OH
43230-4564
US

IV. Provider business mailing address

1110 BEECHER XING N STE C
GAHANNA OH
43230-4564
US

V. Phone/Fax

Practice location:
  • Phone: 614-305-2091
  • Fax:
Mailing address:
  • Phone: 614-305-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.025690
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: