Provider Demographics
NPI:1609322171
Name:WONG, BERTON NAOKI (DDS)
Entity Type:Individual
Prefix:
First Name:BERTON
Middle Name:NAOKI
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PALI HWY STE 211
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2206
Mailing Address - Country:US
Mailing Address - Phone:808-538-1076
Mailing Address - Fax:
Practice Address - Street 1:1300 PALI HWY STE 211
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2206
Practice Address - Country:US
Practice Address - Phone:808-538-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist