Provider Demographics
NPI:1659869741
Name:WONG, NELSON (DDS)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
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 1:3427 ZENITH AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-6747
Mailing Address - Country:US
Mailing Address - Phone:415-713-8333
Mailing Address - Fax:
Practice Address - Street 1:144 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2340
Practice Address - Country:US
Practice Address - Phone:925-830-8989
Practice Address - Fax:925-830-8414
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist