Provider Demographics
NPI:1134384472
Name:WONG, BENITA PEI-LIN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BENITA
Middle Name:PEI-LIN
Last Name:WONG
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:2650 SUZANNE WAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7319
Mailing Address - Country:US
Mailing Address - Phone:541-683-8490
Mailing Address - Fax:541-302-5750
Practice Address - Street 1:2650 SUZANNE WAY
Practice Address - Street 2:SUITE 170
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7319
Practice Address - Country:US
Practice Address - Phone:541-683-8490
Practice Address - Fax:541-302-5750
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD91311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics