Provider Demographics
NPI:1497846430
Name:WONG, WINIFRED S (DDS)
Entity Type:Individual
Prefix:DR
First Name:WINIFRED
Middle Name:S
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 1:39835 PASEO PADRE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2974
Mailing Address - Country:US
Mailing Address - Phone:510-683-8900
Mailing Address - Fax:510-683-9139
Practice Address - Street 1:39835 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2974
Practice Address - Country:US
Practice Address - Phone:510-683-8900
Practice Address - Fax:510-683-9139
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics