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General NPI Number Information
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NPI Number | 1467829887
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Entity Type | Individual
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Provider Name | NITICHAI WONG
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Gender | Male
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 14411 BELLAIRE BLVD
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City | HOUSTON
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State | TX
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Zip | 77083-7521
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Country | US
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Telephone | 281-575-6062
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Fax |
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Provider Business Mailing Address
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Address Line | 12219 ASHFORD MEADOWS DR
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City | SUGAR LAND
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State | TX
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Zip | 77478-6146
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Country | US
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Telephone | 832-293-7680
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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 | 32321
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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 | 31321
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License Number State | TX
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