Provider Demographics
NPI:1750556627
Name:FU WONG DDS PA
Entity type:Organization
Organization Name:FU WONG DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FU
Authorized Official - Middle Name:KEUNG
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-424-4415
Mailing Address - Street 1:7200 HEMLOCK LANE N FU WONG DDS PA
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:763-424-4415
Mailing Address - Fax:763-425-9428
Practice Address - Street 1:7200 HEMLOCK LANE N FU WONG DDS PA
Practice Address - Street 2:SUITE 105
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-424-4415
Practice Address - Fax:763-425-9428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FU WONG DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty