Provider Demographics
NPI:1962254193
Name:BRIAN TONG DENTAL CORP
Entity type:Organization
Organization Name:BRIAN TONG DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-657-5595
Mailing Address - Street 1:23361 EL TORO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4810
Mailing Address - Country:US
Mailing Address - Phone:949-328-9531
Mailing Address - Fax:
Practice Address - Street 1:23361 EL TORO RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4810
Practice Address - Country:US
Practice Address - Phone:949-328-9531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental