Provider Demographics
NPI:1578802450
Name:WALTER RONG DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WALTER RONG DDS, A PROFESSIONAL CORPORATION
Other - Org Name:WALTER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:RONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-339-7012
Mailing Address - Street 1:236 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1906
Mailing Address - Country:US
Mailing Address - Phone:626-339-7012
Mailing Address - Fax:
Practice Address - Street 1:236 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1906
Practice Address - Country:US
Practice Address - Phone:626-339-7012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
CA50094305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental