Individual
MARK E WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6550 FANNIN ST, 2237, HOUSTON, TX 77030-2717
(713) 790-4600
(713) 793-1229
Mailing address
PO BOX 201088, HOUSTON, TX 77216-1088
(713) 500-3500
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
F-21999
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205055101
—
TX
01
—
82X084
BCBS
TX
Enumeration date
07/10/2006
Last updated
12/14/2009
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