Provider Demographics
NPI:1962527549
Name:TONG, MAGGIE W (RDH)
Entity type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:W
Last Name:TONG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 S DE ANZA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3028
Mailing Address - Country:US
Mailing Address - Phone:408-996-8000
Mailing Address - Fax:408-996-8008
Practice Address - Street 1:10311 S DE ANZA BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3028
Practice Address - Country:US
Practice Address - Phone:408-996-8000
Practice Address - Fax:408-996-8008
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21330124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist