Provider Demographics
NPI:1881751519
Name:WONG, ROBERT KAMLUEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KAMLUEN
Last Name:WONG
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 1:29522 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4557
Mailing Address - Country:US
Mailing Address - Phone:734-425-7888
Mailing Address - Fax:734-425-6662
Practice Address - Street 1:29522 6 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4557
Practice Address - Country:US
Practice Address - Phone:734-425-7888
Practice Address - Fax:734-425-6662
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI116511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice