Provider Demographics
NPI:1558538421
Name:WONG, ALAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:WONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E HWY 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3209
Mailing Address - Country:US
Mailing Address - Phone:352-242-1818
Mailing Address - Fax:352-242-4835
Practice Address - Street 1:1455 E HWY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3209
Practice Address - Country:US
Practice Address - Phone:352-242-1818
Practice Address - Fax:352-242-4835
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL155191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260812439Medicaid