Healthcare Provider Details

I. General information

NPI: 1134013477
Provider Name (Legal Business Name): ALEXANDRIA WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 GAME FARM RD
SPRINGFIELD OR
97477-7513
US

IV. Provider business mailing address

6950 NE CAMPUS WAY
HILLSBORO OR
97124-5611
US

V. Phone/Fax

Practice location:
  • Phone: 855-433-6825
  • Fax:
Mailing address:
  • Phone: 855-433-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12251
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: