Individual
DR. BRIAN B FONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
9390 BIG HORN BLVD., SUITE 100, ELK GROVE, CA 95758
(916) 683-7777
(916) 683-8009
Mailing address
9390 BIG HORN BLVD., SUITE 100, ELK GROVE, CA 95758
(916) 683-7777
(916) 683-8009
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
51473
CA
Other
Enumeration date
01/16/2007
Last updated
07/08/2007
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