Provider Demographics
NPI:1730389081
Name:WONG, AUGUSTO V (DDS)
Entity type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:V
Last Name:WONG
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 1:116 WATCHUNG AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-4822
Mailing Address - Country:US
Mailing Address - Phone:908-757-5244
Mailing Address - Fax:908-757-5245
Practice Address - Street 1:116 WATCHUNG AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4822
Practice Address - Country:US
Practice Address - Phone:908-757-5244
Practice Address - Fax:908-757-5245
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI219981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice