Provider Demographics
NPI:1609992064
Name:WONG, MICHAEL PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PETER
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 1:3273 BERRY BROW DR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1066
Mailing Address - Country:US
Mailing Address - Phone:917-604-1800
Mailing Address - Fax:
Practice Address - Street 1:2100 N BROAD ST
Practice Address - Street 2:#203
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1052
Practice Address - Country:US
Practice Address - Phone:215-855-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521991223G0001X
NJ22DI02295500122300000X
PADS0374111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist