Provider Demographics
NPI:1699836031
Name:WONG, GERALD M B (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M B
Last Name:WONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411537 KALANIANAOLE HIGHWAY
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795
Mailing Address - Country:US
Mailing Address - Phone:808-259-9454
Mailing Address - Fax:808-259-5714
Practice Address - Street 1:411537 KALANIANAOLE HIGHWAY
Practice Address - Street 2:SUITE 10B
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795
Practice Address - Country:US
Practice Address - Phone:808-259-9454
Practice Address - Fax:808-259-5714
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice