Provider Demographics
NPI:1881734846
Name:WONG, JERRY YEE (DDS)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:YEE
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5631 TELEPHONE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4485
Mailing Address - Country:US
Mailing Address - Phone:713-644-4446
Mailing Address - Fax:713-644-3338
Practice Address - Street 1:5631 TELEPHONE RD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4485
Practice Address - Country:US
Practice Address - Phone:713-644-4446
Practice Address - Fax:713-644-3338
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1738510-02Medicaid
TX1738510-04Medicaid
TX1738510-06Medicaid