Provider Demographics
NPI:1588829824
Name:WONG, AMY Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:Y
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 1:310 HAPP RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3455
Mailing Address - Country:US
Mailing Address - Phone:847-501-2882
Mailing Address - Fax:847-501-2883
Practice Address - Street 1:310 HAPP RD
Practice Address - Street 2:SUITE 208
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3455
Practice Address - Country:US
Practice Address - Phone:847-501-2882
Practice Address - Fax:847-501-2883
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-169081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice