| NPI | 1235512906 |
|---|---|
| Former Name | HEATHER RENEE WONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 203420) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61761) |
| 122300000X Dentist (Licence: MO 2020031410) | |
| 1223P0300X Dentist, Periodontics (Licence: CA DDS104922) | |
| 1223P0300X Dentist, Periodontics (Licence: OR D11241) | |
| 122300000X Dentist (Licence: MA DN1856936) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-01-10 |