Provider Demographics
NPI:1033214770
Name:WONG, ROSANNA WAI-WEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSANNA
Middle Name:WAI-WEN
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 84TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9344
Mailing Address - Country:US
Mailing Address - Phone:616-878-1514
Mailing Address - Fax:616-878-4014
Practice Address - Street 1:1420 84TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9344
Practice Address - Country:US
Practice Address - Phone:616-878-1514
Practice Address - Fax:616-878-4014
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010185631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice