Provider Demographics
NPI:1770026197
Name:TANYA WONG DDS LLC
Entity Type:Organization
Organization Name:TANYA WONG DDS LLC
Other - Org Name:ADVANCED DENTAL OF DENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-452-7818
Mailing Address - Street 1:490 E MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2484
Mailing Address - Country:US
Mailing Address - Phone:973-586-4444
Mailing Address - Fax:973-586-4455
Practice Address - Street 1:490 E MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2484
Practice Address - Country:US
Practice Address - Phone:973-586-4444
Practice Address - Fax:973-586-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 19422261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental