Provider Demographics
NPI:1194806786
Name:FONG, TERRENCE LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:LEE
Last Name:FONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:9909 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2211
Mailing Address - Country:US
Mailing Address - Phone:626-286-7151
Mailing Address - Fax:626-285-2023
Practice Address - Street 1:9909 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2211
Practice Address - Country:US
Practice Address - Phone:626-286-7151
Practice Address - Fax:626-285-2023
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA263951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics