Individual
MR. YUANBING GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS, 6940 MESA RIDGE PKWY, FOUNTAIN, CO 80817
(434) 332-5919
Mailing address
1667 COCHRANE CIR BLDG 7495, FORT CARSON, CO 80913-4603
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401415431
VA
1223G0001X
General Practice Dentistry
0401415431
VA
1223G0001X
General Practice Dentistry
Primary
DEN.00206132
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401415431
COMMONWEALTH OF VIRGINIA DEPT OF HEALTH PROFESSIONS
VA
01
—
1609325497
NPI
—
Enumeration date
09/22/2016
Last updated
12/30/2024
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