Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 10087 | KY |
N | 213EG0000X | General Practice | 10087 | KY |
Y | 1223X0400X | Orthodontists | 12013004A | IN |
NPI | 1013408954 |
---|---|
Provider Name | Dr. Ariel Biru Wong |
First Address | Indianapolis, IN 46204-2675 |
Second Address | Avon, IN 46123-8475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2018 |
Last Update Date | 07/08/2020 |