MEDICARE: MICHAEL TONG

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	122300000X	Dentist	30491	TX

General Provider Information

NPI Number	:	1780087734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TONG

Provider Business Mailing Address
First Line	:	4431 68TH ST
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4431 68TH STREET
Second Line	:
City	:	APO
State	:	AE
Zip	:	76544-0000
Country	:	US
Telephone Number	:	210-387-1275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	10/06/2014

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Directions to “ MICHAEL TONG ” Practice Location

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