Provider Demographics
NPI:1194521658
Name:ELIZABETH TONG DDS CORP.
Entity type:Organization
Organization Name:ELIZABETH TONG DDS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-251-0962
Mailing Address - Street 1:14055 PERRIS BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4462
Mailing Address - Country:US
Mailing Address - Phone:951-518-9998
Mailing Address - Fax:951-518-9595
Practice Address - Street 1:14055 PERRIS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4462
Practice Address - Country:US
Practice Address - Phone:951-518-9998
Practice Address - Fax:951-518-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102887OtherDENTAL LICENSE