Provider Demographics
NPI:1659432003
Name:GERALD H B WONG DMD INC
Entity Type:Organization
Organization Name:GERALD H B WONG DMD INC
Other - Org Name:DBA WAIMANALO DENTAL AND DBA HAWAII KAI DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:H B
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD INC
Authorized Official - Phone:808-259-9454
Mailing Address - Street 1:41-1537 KALANIANAOLE HWY
Mailing Address - Street 2:SUITE 10-B
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1185
Mailing Address - Country:US
Mailing Address - Phone:808-259-9454
Mailing Address - Fax:808-259-5714
Practice Address - Street 1:41-1537 KALANIANAOLE HWY
Practice Address - Street 2:SUITE 10-B
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1185
Practice Address - Country:US
Practice Address - Phone:808-259-9454
Practice Address - Fax:808-259-5714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERALD H B WONG DMD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPCD 881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty