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General NPI Number Information
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NPI Number | 1770026197
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Entity Type | Organization
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Legal Business Name | TANYA WONG DDS LLC
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 490 E MAIN ST SUITE 103
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City | DENVILLE
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State | NJ
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Zip | 07834-2484
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Country | US
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Telephone | 973-586-4444
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Fax | 973-586-4455
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Provider Business Mailing Address
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Address Line | 490 E MAIN ST SUITE 103
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City | DENVILLE
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State | NJ
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Zip | 07834-2484
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Country | US
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Telephone | 973-586-4444
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Fax | 973-586-4455
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. TANYA WONG
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Credential | DDS
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Telephone | 201-452-7818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DI 19422
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License Number State | NJ
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