Provider Demographics
NPI:1083685358
Name:WONG, ANDRE MING (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:MING
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 CPL EVANS RD
Mailing Address - Street 2:POM DENTAL CLINIC CMD
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:423 CPL EVANS RD
Practice Address - Street 2:POM DENTAL CLINIC CMD
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944
Practice Address - Country:US
Practice Address - Phone:831-242-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice