Provider Demographics
NPI:1023176062
Name:WONG, PERRY DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:DAVID
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7605 CALLE CERCA
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7136
Mailing Address - Country:US
Mailing Address - Phone:661-327-8497
Mailing Address - Fax:661-326-8498
Practice Address - Street 1:4120 TRUXTUN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0425
Practice Address - Country:US
Practice Address - Phone:661-327-8497
Practice Address - Fax:661-326-8498
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics