Provider Demographics
NPI:1174645832
Name:WONG, BILL SOMSAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:SOMSAT
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 1:12715 BEL RED RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2627
Mailing Address - Country:US
Mailing Address - Phone:425-637-6997
Mailing Address - Fax:425-637-1053
Practice Address - Street 1:12715 BEL RED RD STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2627
Practice Address - Country:US
Practice Address - Phone:425-637-6997
Practice Address - Fax:425-637-1053
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000093711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5039755Medicare ID - Type UnspecifiedPROVIDER NUMBER