Provider Demographics
NPI:1356519185
Name:FONG, DUANE (DDS)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12280 SARATOGA SUNNYVALE RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3064
Mailing Address - Country:US
Mailing Address - Phone:408-255-6522
Mailing Address - Fax:
Practice Address - Street 1:12280 SARATOGA SUNNYVALE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-3064
Practice Address - Country:US
Practice Address - Phone:408-255-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist