Provider Demographics
NPI:1801885991
Name:WONG, FU (DDS)
Entity type:Individual
Prefix:DR
First Name:FU
Middle Name:
Last Name:WONG
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 1:4600 COVEY TRL
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55340-4000
Mailing Address - Country:US
Mailing Address - Phone:763-424-4415
Mailing Address - Fax:
Practice Address - Street 1:7200 HEMLOCK LN N
Practice Address - Street 2:SUITE 105
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5576
Practice Address - Country:US
Practice Address - Phone:763-424-4415
Practice Address - Fax:763-425-9428
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist