Provider Demographics
NPI:1962509836
Name:WONG, TERESINA N (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERESINA
Middle Name:N
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 1:638 CASTLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5110
Mailing Address - Country:US
Mailing Address - Phone:925-938-8028
Mailing Address - Fax:
Practice Address - Street 1:2008 COLUMBUS PKWY
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-5400
Practice Address - Country:US
Practice Address - Phone:707-745-3838
Practice Address - Fax:707-745-3847
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice