Provider Demographics
NPI:1538601729
Name:DIANE WONG DDS PLLC
Entity type:Organization
Organization Name:DIANE WONG DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-883-8997
Mailing Address - Street 1:6385 WOODHAVEN BLVD
Mailing Address - Street 2:APT. 3G
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:254 CANAL ST
Practice Address - Street 2:ROOM 4008
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3501
Practice Address - Country:US
Practice Address - Phone:212-966-3649
Practice Address - Fax:212-966-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-05
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0469461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty