Provider Demographics
NPI:1902825664
Name:WONG, STANLEY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:WONG
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 1:704 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5403
Mailing Address - Country:US
Mailing Address - Phone:408-629-3366
Mailing Address - Fax:408-629-3370
Practice Address - Street 1:704 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-5403
Practice Address - Country:US
Practice Address - Phone:408-629-3366
Practice Address - Fax:408-629-3370
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice