Provider Demographics
NPI:1114180460
Name:ONG, DAVID A (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ONG
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 1:1125 SILVER LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:651-842-8426
Mailing Address - Fax:651-815-0379
Practice Address - Street 1:1125 SILVER LAKE ROAD
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:651-842-8426
Practice Address - Fax:651-815-0379
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND123181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice