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General NPI Number Information
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NPI Number | 1548614092
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Entity Type | Individual
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Provider Name | JASON WONG DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 3925 W BOYNTON BEACH BLVD STE 106
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4500
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Country | US
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Telephone | 561-734-2001
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Fax | 561-734-2001
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Provider Business Mailing Address
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Address Line | 3925 W BOYNTON BEACH BLVD STE 106
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4500
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Country | US
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Telephone | 561-734-2001
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Fax | 561-734-8234
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 25689
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License Number State | FL
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