Provider Demographics
NPI:1912364449
Name:WONG, WINNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WINNIE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18110 NORTHERN DANCER LN
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-6107
Mailing Address - Country:US
Mailing Address - Phone:301-928-9181
Mailing Address - Fax:
Practice Address - Street 1:7810 WORMANS MILL RD
Practice Address - Street 2:STE D
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3035
Practice Address - Country:US
Practice Address - Phone:301-378-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice