Provider Demographics
NPI:1518952639
Name:WONG, ANNIE LOUIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:LOUIE
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 1:520 LA GONDA WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1741
Mailing Address - Country:US
Mailing Address - Phone:925-837-0541
Mailing Address - Fax:925-837-0542
Practice Address - Street 1:520 LA GONDA WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1741
Practice Address - Country:US
Practice Address - Phone:925-837-0541
Practice Address - Fax:925-837-0542
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice