Provider Demographics
NPI:1578533139
Name:WONG, HENRY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:C
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17 ELIZABETH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4803
Mailing Address - Country:US
Mailing Address - Phone:212-966-8976
Mailing Address - Fax:212-966-8814
Practice Address - Street 1:17 ELIZABETH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4803
Practice Address - Country:US
Practice Address - Phone:212-966-8976
Practice Address - Fax:212-966-8814
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0409211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice