Provider Demographics
NPI:1326176462
Name:WONG, TERENCE CHUCK (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:CHUCK
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 1:19845 LAKE CHABOT RD
Mailing Address - Street 2:SUITE #210
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4055
Mailing Address - Country:US
Mailing Address - Phone:510-581-7788
Mailing Address - Fax:510-581-6872
Practice Address - Street 1:19845 LAKE CHABOT RD
Practice Address - Street 2:SUITE #210
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4055
Practice Address - Country:US
Practice Address - Phone:510-581-7788
Practice Address - Fax:510-581-6872
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice