Provider Demographics
NPI:1427058585
Name:XU-WONG, SUSAN X (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:X
Last Name:XU-WONG
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 1:726 GEARY ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-4822
Mailing Address - Country:US
Mailing Address - Phone:541-928-9990
Mailing Address - Fax:541-928-1101
Practice Address - Street 1:726 GEARY ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-4822
Practice Address - Country:US
Practice Address - Phone:541-928-9990
Practice Address - Fax:541-928-1101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD70421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice