Healthcare Provider Details

I. General information

NPI: 1962980961
Provider Name (Legal Business Name): CALVIN WAH NGO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W MONTGOMERY ST STE B
WILLIS TX
77378-8827
US

IV. Provider business mailing address

17474 BAYFLOWER
CONROE TX
77385-2238
US

V. Phone/Fax

Practice location:
  • Phone: 936-701-5010
  • Fax:
Mailing address:
  • Phone: 832-290-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD010109
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34909
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: