Provider Demographics
NPI:1346635794
Name:COSMETIC AND FAMILY DENTISTRY LANA WONG DDS PC
Entity Type:Organization
Organization Name:COSMETIC AND FAMILY DENTISTRY LANA WONG DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-755-3310
Mailing Address - Street 1:205 S DOBSON RD
Mailing Address - Street 2:#3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6183
Mailing Address - Country:US
Mailing Address - Phone:480-755-3310
Mailing Address - Fax:
Practice Address - Street 1:205 S DOBSON RD
Practice Address - Street 2:#3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6183
Practice Address - Country:US
Practice Address - Phone:480-755-3310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty