Provider Demographics
NPI:1255490215
Name:WONG, JONATHAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
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 1:1186 LYNNHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4814
Mailing Address - Country:US
Mailing Address - Phone:757-468-4867
Mailing Address - Fax:757-368-0797
Practice Address - Street 1:1186 LYNNHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4814
Practice Address - Country:US
Practice Address - Phone:757-468-4861
Practice Address - Fax:757-368-0797
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice