Provider Demographics
NPI:1790868594
Name:SO, BILL KWOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:KWOK
Last Name:SO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9623 MARLIVE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-4805
Mailing Address - Country:US
Mailing Address - Phone:713-498-2217
Mailing Address - Fax:
Practice Address - Street 1:4410 WESTWAY PARK BLVD STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-2039
Practice Address - Country:US
Practice Address - Phone:713-690-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice