Basic Information
| Provider Information | |||||||||
| NPI: | 1144222084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | PERRY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | MARIPOSA INDIAN HEALTH CLINIC | ||||||||
| Address2: | PO BOX 1569 | ||||||||
| City: | MARIPOSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953381569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099660573 | ||||||||
| FaxNumber: | 2097426321 | ||||||||
| Practice Location | |||||||||
| Address1: | MARIPOSA INDIAN HEALTH CLINIC | ||||||||
| Address2: | 5192 HOSPITAL ROAD | ||||||||
| City: | MARIPOSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953381569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099660573 | ||||||||
| FaxNumber: | 2097426321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 41327 | CA | Y | Dental Providers | Dentist |
No ID Information.