Organization
HENRY K PONG, DDS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY K PONG DDS (PRESIDENT)
(219) 962-8666
Entity
Organization
Contact information
Practice address
3820 CENTRAL AVE, LAKE STATION, IN 46405-2324
(219) 962-8666
Mailing address
3820 CENTRAL AVE, LAKE STATION, IN 46405-2324
(219) 962-8666
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
54000645
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100167920A
—
IN
Enumeration date
09/17/2006
Last updated
02/19/2013
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