Provider Demographics
NPI:1841542388
Name:ALLEN M.O. WONG, DDS
Entity type:Organization
Organization Name:ALLEN M.O. WONG, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MARN KEONG
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:808-538-7279
Mailing Address - Street 1:1300 PALI HWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2206
Mailing Address - Country:US
Mailing Address - Phone:808-538-1076
Mailing Address - Fax:808-538-1076
Practice Address - Street 1:1300 PALI HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2206
Practice Address - Country:US
Practice Address - Phone:808-538-1076
Practice Address - Fax:808-538-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1223OtherHAWAII DENTAL SERVICE
HI000851997OtherHAWAII MEDICAL SERVICE ASSOCIATION