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General NPI Number Information
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NPI Number | 1124841986
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Entity Type | Organization
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Legal Business Name | GARRETT S. FONG, D.M.D., INC.
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 9909 EAST LAS TUNAS DRIVE
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City | TEMPLE CITY
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State | CA
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Zip | 91780
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Country | US
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Telephone | 626-286-7151
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Fax |
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Provider Business Mailing Address
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Address Line | 620 W LONGDEN AVE
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City | ARCADIA
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State | CA
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Zip | 91007-8135
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Country | US
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Telephone | 626-447-6770
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARRETT SCOTT FONG
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Credential | DMD
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Telephone | 626-286-7151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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