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NPI Code Detail

MEDICARE: DR. LANA LEE WONG DDS

MEDICARE: DR. LANA LEE WONG DDS
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
1122300000XDentistD5449AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1620650OTHERAZSTATE

General Provider Information

NPI Number : 1538124268
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LANA LEE WONG DDS
Provider Business Mailing Address
First Line : PO BOX 188
Second Line :
City : MARANA
State : AZ
Zip : 85653-0188
Country : US
Telephone Number : 520-616-6200
Fax Number : 520-682-1087
Provider Business Practice Location Address
First Line : 13395 N MARANA MAIN ST
Second Line :
City : MARANA
State : AZ
Zip : 85653-7008
Country : US
Telephone Number : 520-616-6200
Fax Number : 520-682-1087
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2006
Last Update Date : 01/29/2024

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Directions to “ DR. LANA LEE WONG DDS” Practice Location

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