Provider Demographics
NPI:1679690911
Name:ALBERT G. WONG, D.M.D., P.A.
Entity Type:Organization
Organization Name:ALBERT G. WONG, D.M.D., P.A.
Other - Org Name:OASIS DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-791-4100
Mailing Address - Street 1:300 NW 70TH AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2384
Mailing Address - Country:US
Mailing Address - Phone:954-791-4100
Mailing Address - Fax:954-791-4680
Practice Address - Street 1:300 NW 70TH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2384
Practice Address - Country:US
Practice Address - Phone:954-791-4100
Practice Address - Fax:954-791-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN133181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty