Provider Demographics
NPI:1982943007
Name:RONG, WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:RONG
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 1:546 W BADILLO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3786
Mailing Address - Country:US
Mailing Address - Phone:626-339-7012
Mailing Address - Fax:626-339-7010
Practice Address - Street 1:546 W BADILLO ST
Practice Address - Street 2:SUITE A
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3786
Practice Address - Country:US
Practice Address - Phone:626-339-7012
Practice Address - Fax:626-339-7010
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist