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NPI Code Detail

MEDICARE: DR. VALERIE C FONG DDS

MEDICARE: DR. VALERIE C FONG 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
11223G0001XGeneral Practice DentistryDN1855545MA
21223G0001XGeneral Practice Dentistry58847CA
31223P0221XPediatric DentistryDN1855545MA
4390200000XStudent in an Organized Health Care Education/Training Program
51223P0221XPediatric Dentistry29791TX

General Provider Information

NPI Number : 1912231333
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VALERIE C FONG DDS
Provider Business Mailing Address
First Line : 1015 W 34TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78705-2008
Country : US
Telephone Number : 512-206-2929
Fax Number :
Provider Business Practice Location Address
First Line : 1015 W 34TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78705-2008
Country : US
Telephone Number : 512-206-2929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2009
Last Update Date : 12/22/2020

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