Provider Demographics
NPI:1528143666
Name:WONG, DENNIS K (DDS)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:K
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 1:14419 S BASCOM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2046
Mailing Address - Country:US
Mailing Address - Phone:408-559-8188
Mailing Address - Fax:
Practice Address - Street 1:14419 S BASCOM AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2046
Practice Address - Country:US
Practice Address - Phone:408-559-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice