Individual
RICHARD WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
845 S. MAIN ST #300, LOMBARD, IL 60148
(630) 620-1980
Mailing address
450 WARRENVILLE RD APT #340, LISLE, IL 60532
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019031389
IL
Other
Enumeration date
09/05/2017
Last updated
09/05/2017
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