# HENRY K PONG, DDS, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174620769
- **Authorized official:** DR. HENRY K PONG DDS (PRESIDENT)
- **Authorized official phone:** (219) 962-8666

## Contact information

- **Practice address:** 3820 CENTRAL AVE, LAKE STATION, IN 46405-2324
- **Practice address phone:** (219) 962-8666
- **Mailing address:** 3820 CENTRAL AVE, LAKE STATION, IN 46405-2324
- **Mailing address phone:** (219) 962-8666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 54000645 | IN | Yes |

## Other

- **Enumeration date:** 09/17/2006
- **Last updated:** 02/19/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100167920A | — | IN |