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Provider Information for 1912062019



DENNIS DAVID WONG DDS

Gender: MALE

Individual NPI: 1912062019

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1912062019
Enumeration Date 2006-12-27
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 930 FLORIN RD STE 100
SACRAMENTO, CA 95831-5002
United States

Phone: 916-395-5700 | Fax:
View Map External Link
Primary Practice Address 930 FLORIN RD STE 100
SACRAMENTO, CA 95831-5002
United States

Phone: 916-395-5700 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 25853