Individual
STEPHEN TAKASHI GONG WAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
38149 MARTHA AVE, FREMONT, CA 94536-3800
(510) 797-4430
(510) 797-4615
Mailing address
38149 MARTHA AVE, FREMONT, CA 94536-3800
(510) 797-4430
(510) 797-4615
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
54677
CA
Other
Enumeration date
08/23/2010
Last updated
08/23/2010
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