MEDICARE: BERT ONG DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 6246	FL

General Provider Information

NPI Number	:	1225124845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERT ONG DMD PA

Provider Business Mailing Address
First Line	:	4435 CURRY FORD ROAD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812
Country	:	US
Telephone Number	:	407-275-7700
Fax Number	:	407-275-1226

Provider Business Practice Location Address
First Line	:	4435 CURRY FORD ROAD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812
Country	:	US
Telephone Number	:	407-275-7700
Fax Number	:	407-275-1226

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BERT ONG
Credential	:	DMD
Telephone Number	:	407-275-7700

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/22/2020

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