Individual
JASON WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3101 W INDIAN SCHOOL RD, PHOENIX, AZ 85017-4035
(602) 861-3333
Mailing address
4422 N 75TH ST UNIT 6008, SCOTTSDALE, AZ 85251-4080
(347) 768-9224
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
057530
NY
122300000X
Dentist
9559
AZ
1223D0004X
Dental Anesthesiology
Primary
9559
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2013
Last updated
10/01/2023
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