Provider Demographics
NPI:1730362575
Name:KWONG, CYRUS DOT (DDS)
Entity type:Individual
Prefix:
First Name:CYRUS
Middle Name:DOT
Last Name:KWONG
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 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:407-772-5124
Mailing Address - Fax:407-788-3572
Practice Address - Street 1:748 S MEADOWS PKWY
Practice Address - Street 2:SUITE 8
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3861
Practice Address - Country:US
Practice Address - Phone:775-851-9099
Practice Address - Fax:775-851-9055
Is Sole Proprietor?:No
Enumeration Date:2007-12-16
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5686122300000X
CA55335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist