Provider Demographics
NPI:1679660971
Name:WONG, STEVEN (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
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 1:4611 FREEPORT BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2014
Mailing Address - Country:US
Mailing Address - Phone:916-737-8383
Mailing Address - Fax:916-737-8384
Practice Address - Street 1:4611 FREEPORT BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-2014
Practice Address - Country:US
Practice Address - Phone:916-737-8383
Practice Address - Fax:916-737-8384
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0506951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice