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General NPI Number Information
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NPI Number | 1437340452
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Entity Type | Individual
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Provider Name | STEFANIE A WONG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 3156 MAGIC HOLLOW BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-3011
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Country | US
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Telephone | 757-468-4867
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Fax | 757-368-0797
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Provider Business Mailing Address
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Address Line | 3156 MAGIC HOLLOW BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-3011
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Country | US
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Telephone | 757-468-4867
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Fax | 757-368-0797
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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 | 0401411828
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License Number State | VA
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