Provider Demographics
NPI:1447314976
Name:WONG, BRIAN (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
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 1:9300 WADE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:469-598-1998
Mailing Address - Fax:972-435-7757
Practice Address - Street 1:9300 WADE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:469-598-1998
Practice Address - Fax:972-435-7757
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice