Provider Demographics
NPI:1245391127
Name:WONG, EMELITA MARGUEZ (DDS)
Entity type:Individual
Prefix:DR
First Name:EMELITA
Middle Name:MARGUEZ
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 1:1600 DEMPSTER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-298-4436
Mailing Address - Fax:847-298-4593
Practice Address - Street 1:1600 DEMPSTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-298-4436
Practice Address - Fax:847-298-4593
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist