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1206 Laskin Rd Ste 140 Virginia Beach VA 23451-5267 | |
| (757) 598-2958 | |
| (757) 425-1762 |
| Full Name | |
|---|---|
| Speciality | Dentist - Dentist Anesthesiologist |
| Location | 1206 Laskin Rd Ste 140, Virginia Beach, Virginia |
| Authorized Official Name and Position | Jonathan Lawrence Wong (OWNER) |
| Authorized Official Contact | 7575982958 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
303 55th St Unit A Virginia Beach VA 23451-2213 Ph: (757) 598-2958 | 1206 Laskin Rd Ste 140 Virginia Beach VA 23451-5267 Ph: (757) 598-2958 |
| NPI Number | 1831629419 |
|---|---|
| Provider Enumeration Date | 06/15/2017 |
| Last Update Date | 03/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831629419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0004X | Dentist - Dentist Anesthesiologist | 0447000045 (Virginia) | Primary |
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