Provider Demographics
NPI:1629082755
Name:WONG, CATHERINE M (D D S)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:WONG
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3025
Mailing Address - Country:US
Mailing Address - Phone:219-923-8873
Mailing Address - Fax:219-923-8873
Practice Address - Street 1:408 E 86TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6211
Practice Address - Country:US
Practice Address - Phone:219-769-8788
Practice Address - Fax:219-769-8978
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008742A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice