Individual
BRIAN R FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
21048 HAVILAND AVE, HAYWARD, CA 94541-2036
(510) 581-2142
Mailing address
21048 HAVILAND AVE, HAYWARD, CA 94541-2036
(510) 581-2142
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
38994
CA
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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