MEDICARE: DR. ERIC JUSTIN TONG 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	122300000X	Dentist	10401448-9921	UT
2	1223G0001X	General Practice Dentistry	34980	TX
3	122300000X	Dentist	34980	TX

General Provider Information

NPI Number	:	1821512765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC JUSTIN TONG DDS

Provider Business Mailing Address
First Line	:	4070 STANLEY RD BLDG 1029
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-2714
Country	:	US
Telephone Number	:	210-221-0826
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 STANLEY RD BLDG 2375
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-2740
Country	:	US
Telephone Number	:	210-295-4156
Fax Number	:

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

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	05/30/2024

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