Organization
C F WONG BETA DENTAL INCORPORATED
Active
Other names
Magnolia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER F. WONG DDS (OWNER)
(805) 543-6963
Entity
Organization
Contact information
Practice address
1042 PACIFIC ST STE B, SAN LUIS OBISPO, CA 93401-3661
(805) 543-6963
(805) 543-8656
Mailing address
1042 PACIFIC ST STE B, SAN LUIS OBISPO, CA 93401-3661
(805) 543-6963
(805) 543-8656
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
05/09/2018
Last updated
06/16/2018
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