Provider Demographics
NPI:1689914194
Name:ALICIA K. WONG, DMD, MPH, PLLC
Entity Type:Organization
Organization Name:ALICIA K. WONG, DMD, MPH, PLLC
Other - Org Name:ART OF PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:425-401-1147
Mailing Address - Street 1:914 140TH AVE NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3482
Mailing Address - Country:US
Mailing Address - Phone:425-401-1147
Mailing Address - Fax:425-484-6424
Practice Address - Street 1:914 140TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3482
Practice Address - Country:US
Practice Address - Phone:425-401-1147
Practice Address - Fax:425-484-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty