MEDICARE: DR. CALVIN WAH NGO DMD

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	D010109	AZ
2	1223G0001X	General Practice Dentistry	34909	TX

General Provider Information

NPI Number	:	1962980961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALVIN WAH NGO DMD

Provider Business Mailing Address
First Line	:	17474 BAYFLOWER
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77385-2238
Country	:	US
Telephone Number	:	832-290-3936
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W MONTGOMERY ST STE B
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-8827
Country	:	US
Telephone Number	:	936-701-5010
Fax Number	:

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

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	05/01/2024

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