Provider Demographics
NPI:1366503997
Name:ONG, EVERETT SOONKEN (DDS)
Entity type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:SOONKEN
Last Name:ONG
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 1:82 KINGPIN LOOP
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5495
Mailing Address - Country:US
Mailing Address - Phone:575-562-0220
Mailing Address - Fax:
Practice Address - Street 1:27TH SPECIAL OPERATIONS MEDICAL GROUP
Practice Address - Street 2:224 W D.L.INGRAM AVE., BLDG 1408
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103-5495
Practice Address - Country:US
Practice Address - Phone:575-904-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice