Provider Demographics
NPI:1518294792
Name:HONG, MARRY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARRY
Middle Name:LEE
Last Name:HONG
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 1:2925 KELLER SPRINGS RD APT 118
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4887
Mailing Address - Country:US
Mailing Address - Phone:214-675-2007
Mailing Address - Fax:
Practice Address - Street 1:13901 MIDWAY RD
Practice Address - Street 2:STE 106A
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-4359
Practice Address - Country:US
Practice Address - Phone:972-239-4777
Practice Address - Fax:972-239-5542
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice