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General NPI Number Information
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NPI Number | 1811214356
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Entity Type | Organization
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Legal Business Name | ERIC T. WONG D.D.S., A PROFESSIONAL CORP
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 23326 HAWTHORNE BLVD STE 310
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City | TORRANCE
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State | CA
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Zip | 90505-3757
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Country | US
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Telephone | 310-378-4220
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Fax | 310-378-9222
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Provider Business Mailing Address
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Address Line | 23326 HAWTHORNE BLVD STE 310
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City | TORRANCE
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State | CA
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Zip | 90505-3757
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Country | US
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Telephone | 310-378-4220
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Fax | 310-378-9222
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC THOMAS WONG
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Credential | D.D.S.
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Telephone | 310-259-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 58395
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License Number State | CA
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