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General NPI Number Information
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NPI Number | 1316080088
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Entity Type | Organization
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Legal Business Name | NORTHWEST FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 2120 W 18TH ST
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City | HOUSTON
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State | TX
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Zip | 77008-1210
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Country | US
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Telephone | 713-861-7078
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Fax | 713-861-8065
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Provider Business Mailing Address
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Address Line | 2120 W 18TH ST
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City | HOUSTON
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State | TX
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Zip | 77008-1210
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Country | US
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Telephone | 713-861-7078
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Fax | 713-861-8065
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. ANDREW WONG
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Credential | D.D.S.
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Telephone | 713-861-7078
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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 | 15415
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15764
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License Number State | TX
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