Provider Demographics
NPI:1619201936
Name:TON, CONG THAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONG
Middle Name:THAT
Last Name:TON
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 1:9232 CHELSEA CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6512
Mailing Address - Country:US
Mailing Address - Phone:714-823-6325
Mailing Address - Fax:
Practice Address - Street 1:9232 CHELSEA CIR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6512
Practice Address - Country:US
Practice Address - Phone:714-823-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist