Provider Demographics
NPI:1154844264
Name:WONG, PATRICK ELLIOTT (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ELLIOTT
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7527
Mailing Address - Country:US
Mailing Address - Phone:972-809-7187
Mailing Address - Fax:
Practice Address - Street 1:3000 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226
Practice Address - Country:US
Practice Address - Phone:214-828-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330141223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice