Provider Demographics
NPI:1437340452
Name:WONG, STEFANIE A (DDS)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:A
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 MAGIC HOLLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3011
Mailing Address - Country:US
Mailing Address - Phone:757-468-4867
Mailing Address - Fax:757-368-0797
Practice Address - Street 1:3156 MAGIC HOLLOW BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3011
Practice Address - Country:US
Practice Address - Phone:757-468-4867
Practice Address - Fax:757-368-0797
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice