Individual
DERRICK B WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1111 E OCEAN AVE, SUITE 5, LOMPOC, CA 93436-7076
(805) 735-9200
(805) 735-9550
Mailing address
1111 E OCEAN AVE, SUITE 5, LOMPOC, CA 93436-7076
(805) 735-9200
(805) 735-9550
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
47433
CA
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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