Provider Demographics
NPI:1730267758
Name:DONOVAN, DORA WONG (DMD,MDS)
Entity type:Individual
Prefix:DR
First Name:DORA
Middle Name:WONG
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:DMD,MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 RANCHO NIGUEL RD STE 160
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7306
Mailing Address - Country:US
Mailing Address - Phone:949-831-7790
Mailing Address - Fax:949-831-7035
Practice Address - Street 1:25500 RANCHO NIGUEL RD STE 160
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7306
Practice Address - Country:US
Practice Address - Phone:949-831-7790
Practice Address - Fax:949-831-7035
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics