Provider Demographics
NPI:1396886503
Name:DONG, ROBERT X (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:X
Last Name:DONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 FREEPORT BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822
Mailing Address - Country:US
Mailing Address - Phone:916-454-0566
Mailing Address - Fax:916-454-1198
Practice Address - Street 1:4611 FREEPORT BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822
Practice Address - Country:US
Practice Address - Phone:916-454-0566
Practice Address - Fax:916-454-1198
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice