Individual
DR. JENNIE WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
8527 BROADWAY, ELMHURST, NY 11373-5837
(718) 898-0900
Mailing address
8527 BROADWAY, ELMHURST, NY 11373-5837
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
055560
NY
Other
Enumeration date
06/10/2011
Last updated
06/05/2014
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