Provider Demographics
NPI:1689192072
Name:TONG, CHARLENE (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26730 TOWNE CENTRE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2857
Mailing Address - Country:US
Mailing Address - Phone:949-859-8599
Mailing Address - Fax:949-859-1333
Practice Address - Street 1:26730 TOWNE CENTRE DR STE 101
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2857
Practice Address - Country:US
Practice Address - Phone:949-859-8599
Practice Address - Fax:949-859-1333
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450381223G0001X
CADDS450381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice