Provider Demographics
NPI:1922212745
Name:NGE NGE, MOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOE
Middle Name:
Last Name:NGE NGE
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 1:2815 BLANDFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4820
Mailing Address - Country:US
Mailing Address - Phone:626-581-1674
Mailing Address - Fax:626-581-1674
Practice Address - Street 1:8317 PAINTER AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3063
Practice Address - Country:US
Practice Address - Phone:562-945-5239
Practice Address - Fax:562-945-5259
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice