Provider Demographics
NPI:1427262971
Name:WONG, TERRY M (DDS)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:M
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2713
Mailing Address - Country:US
Mailing Address - Phone:206-682-4166
Mailing Address - Fax:206-682-0544
Practice Address - Street 1:307 6TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2713
Practice Address - Country:US
Practice Address - Phone:206-682-4166
Practice Address - Fax:206-682-0544
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA48201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice