Provider Demographics
NPI:1114251386
Name:WONG, MAYRA EDITH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:EDITH
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 DRUMMOND ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2420
Mailing Address - Country:US
Mailing Address - Phone:281-501-3929
Mailing Address - Fax:
Practice Address - Street 1:909 DAIRY ASHFORD ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5309
Practice Address - Country:US
Practice Address - Phone:281-752-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248641223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics