Provider Demographics
NPI:1588723100
Name:WONG, STEVEN C (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:WONG
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1001 N HICKORY RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3702
Mailing Address - Country:US
Mailing Address - Phone:574-288-8600
Mailing Address - Fax:574-288-6911
Practice Address - Street 1:1001 N HICKORY RD
Practice Address - Street 2:SUITE 9
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3702
Practice Address - Country:US
Practice Address - Phone:574-288-8600
Practice Address - Fax:574-288-6911
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN120093841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics