Individual
CHUNG KWANG RAYMOND WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S., M.S.D.
Contact information
Practice address
6920 PARKDALE PL, SUITE 217, INDIANAPOLIS, IN 46254-5612
(317) 328-6708
(317) 328-6888
Mailing address
6920 PARKDALE PL, SUITE 217, INDIANAPOLIS, IN 46254-5612
(317) 328-6708
(317) 328-6888
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009381
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12009381A
—
IN
Enumeration date
09/26/2006
Last updated
07/08/2007
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