Provider Demographics
NPI:1538256391
Name:WONG, ALAN (DDS)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
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 1:1851 W 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5044
Mailing Address - Country:US
Mailing Address - Phone:303-429-6411
Mailing Address - Fax:303-429-0118
Practice Address - Street 1:1851 W 84TH AVE
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-5044
Practice Address - Country:US
Practice Address - Phone:303-429-6411
Practice Address - Fax:303-429-0118
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist