Provider Demographics
NPI:1629140637
Name:FONG, DAVID M (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:FONG
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 1:1730 FRANKLIN ST
Mailing Address - Street 2:SUITE #302
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612
Mailing Address - Country:US
Mailing Address - Phone:510-452-1156
Mailing Address - Fax:510-452-1013
Practice Address - Street 1:1730 FRANKLIN ST
Practice Address - Street 2:SUITE #302
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612
Practice Address - Country:US
Practice Address - Phone:510-452-1156
Practice Address - Fax:510-452-1013
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist