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General NPI Number Information
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NPI Number | 1245767425
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Entity Type | Individual
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Provider Name | TITUS WONGK DMD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2017
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 5901 PEACHTREE DUNWOODY RD STE B250
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City | ATLANTA
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State | GA
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Zip | 30328-7150
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Country | US
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Telephone | 470-713-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 5901 PEACHTREE DUNWOODY RD STE B250
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City | ATLANTA
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State | GA
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Zip | 30328-7150
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Country | US
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Telephone | 470-713-6770
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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 | D123381
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License Number State | GA
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