MEDICARE: DR. MELISSA 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
1	1223G0001X	General Practice Dentistry	38459	TX

General Provider Information

NPI Number	:	1801526090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA WONG DDS

Provider Business Mailing Address
First Line	:	2418 BROOKMERE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1141
Country	:	US
Telephone Number	:	832-533-6170
Fax Number	:

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	:

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

Provider Enumeration Date	:	06/12/2022
Last Update Date	:	06/12/2022

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