Provider Demographics
NPI:1528542073
Name:WONG, SING WAI (DDS, MS, PHD)
Entity Type:Individual
Prefix:
First Name:SING WAI
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 N GRANDVIEW AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3040
Mailing Address - Country:US
Mailing Address - Phone:432-538-3318
Mailing Address - Fax:
Practice Address - Street 1:1508 N GRANDVIEW AVE STE 1
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3040
Practice Address - Country:US
Practice Address - Phone:432-538-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1512241223P0300X
TX380961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics