MEDICARE: MENG TONG DDS LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1619521903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENG TONG DDS LLC

Provider Business Mailing Address
First Line	:	1240 CRESCENT HEIGHTS RD
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6408
Country	:	US
Telephone Number	:	740-387-5196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 CRESCENT HEIGHTS RD
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6408
Country	:	US
Telephone Number	:	614-526-4958
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MENG TONG
Credential	:	DDS
Telephone Number	:	614-905-2745

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	07/13/2020

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