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General NPI Number Information
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NPI Number | 1083685358
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Entity Type | Individual
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Provider Name | ANDRE MING WONG DDS
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 423 CPL EVANS RD POM DENTAL CLINIC CMD
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City | MONTEREY
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State | CA
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Zip | 93944
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Country | US
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Telephone | 831-242-5612
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Fax |
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Provider Business Mailing Address
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Address Line | 423 CPL EVANS RD POM DENTAL CLINIC CMD
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City | MONTEREY
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State | CA
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Zip | 93944
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 48866
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License Number State | CA
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