Provider Demographics
NPI:1942687926
Name:JEFFREY H WONG, D.D.S. M.S.
Entity type:Organization
Organization Name:JEFFREY H WONG, D.D.S. M.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-444-6680
Mailing Address - Street 1:3400 PENROSE PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1809
Mailing Address - Country:US
Mailing Address - Phone:303-444-6680
Mailing Address - Fax:303-473-0705
Practice Address - Street 1:3400 PENROSE PL
Practice Address - Street 2:SUITE 203
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1809
Practice Address - Country:US
Practice Address - Phone:303-444-6680
Practice Address - Fax:303-473-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8169261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental