MEDICARE: ANDREW WONG D.D.S.

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	15764	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790958007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW WONG D.D.S.

Provider Business Mailing Address
First Line	:	2120 W 18TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1210
Country	:	US
Telephone Number	:	713-861-7078
Fax Number	:	713-861-8065

Provider Business Practice Location Address
First Line	:	2120 W 18TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1210
Country	:	US
Telephone Number	:	713-861-7078
Fax Number	:	713-861-8065

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

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	05/20/2019

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Directions to “ ANDREW WONG D.D.S.” Practice Location

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