Provider Demographics
NPI:1396727194
Name:FONG, PATRICIA F (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:F
Last Name:FONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 SOUTH LAND PARK DR
Mailing Address - Street 2:#C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831
Mailing Address - Country:US
Mailing Address - Phone:916-424-1466
Mailing Address - Fax:916-424-4645
Practice Address - Street 1:7210 SOUTH LAND PARK DR
Practice Address - Street 2:#C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831
Practice Address - Country:US
Practice Address - Phone:916-424-1466
Practice Address - Fax:916-424-4645
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist