Individual
DERRICK WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1901 BABCOCK RD STE 201, SAN ANTONIO, TX 78229-4546
(903) 292-8131
Mailing address
8911 ARANSAS BAY, SAN ANTONIO, TX 78229-2380
(903) 292-8131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
40431
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/01/2023
Last updated
01/06/2025
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