Provider Demographics
NPI:1902895246
Name:NG, WAI PONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:WAI
Middle Name:PONG
Last Name:NG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 CUBERO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3879
Mailing Address - Country:US
Mailing Address - Phone:505-797-3530
Mailing Address - Fax:505-797-2155
Practice Address - Street 1:5900 CUBERO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3879
Practice Address - Country:US
Practice Address - Phone:505-797-3530
Practice Address - Fax:505-797-2155
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77607236Medicaid