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General NPI Number Information
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NPI Number | 1770786782
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Entity Type | Organization
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Legal Business Name | DENNIS R WONG DMD PC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2241 S AVE. A SUITE 7
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City | YUMA
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State | AZ
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Zip | 85364
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Country | US
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Telephone | 928-783-0636
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Fax | 928-783-0054
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Provider Business Mailing Address
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Address Line | 2241 S AVENUE A SUITE #7
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City | YUMA
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State | AZ
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Zip | 85364
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Country | US
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Telephone | 928-783-0636
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Fax | 928-783-0054
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS ROY WONG
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Credential | DMD
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Telephone | 928-783-0636
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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 | 3355
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License Number State | AZ
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