Provider Demographics
NPI:1407910540
Name:WONG, ALLEN MO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:MO
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 1:1300 PALI HWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2230
Mailing Address - Country:US
Mailing Address - Phone:808-538-1076
Mailing Address - Fax:808-538-1076
Practice Address - Street 1:1300 PALI HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2230
Practice Address - Country:US
Practice Address - Phone:808-538-1076
Practice Address - Fax:808-538-1076
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1223OtherHAWAII LICENSE NUMBER
HI000851997OtherHAWAII MEDICAL SERVICE ASSOCIATION