Provider Demographics
NPI:1912081225
Name:WONG, PAMELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 9TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6523
Mailing Address - Country:US
Mailing Address - Phone:510-909-1099
Mailing Address - Fax:510-795-7229
Practice Address - Street 1:4288 DUBLIN BLVD STE 209
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3172
Practice Address - Country:US
Practice Address - Phone:925-829-9884
Practice Address - Fax:925-829-0184
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist