Individual
DR. DEBRA A GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
820 S DAMEN AVE, DENTAL SERVICE, JESSE BROWN VAMC, CHICAGO, IL 60612-3728
(312) 569-6669
Mailing address
3200 N LAKE SHORE DR, #711, CHICAGO, IL 60657-3952
(919) 824-1748
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8222
NC
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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