Provider Demographics
NPI:1225413511
Name:KONG, CINDY (DMD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 OLD DEERFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3703
Mailing Address - Country:US
Mailing Address - Phone:856-455-7014
Mailing Address - Fax:
Practice Address - Street 1:102 OLD DEERFIELD PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3703
Practice Address - Country:US
Practice Address - Phone:856-455-7014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02608300122300000X
PADS040391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist