Provider Demographics
NPI:1659896462
Name:WONG BLUE OCEAN DENTAL OFFICE PC
Entity Type:Organization
Organization Name:WONG BLUE OCEAN DENTAL OFFICE PC
Other - Org Name:WONG BLUE OCEAN DENTAL OFFICE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-852-6999
Mailing Address - Street 1:408 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4801
Mailing Address - Country:US
Mailing Address - Phone:626-852-6999
Mailing Address - Fax:
Practice Address - Street 1:408 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4801
Practice Address - Country:US
Practice Address - Phone:626-852-6999
Practice Address - Fax:626-852-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental