Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 24864 | TX |
NPI | 1114251386 |
---|---|
Provider Name | Dr. Mayra Edith Wong |
First Address | Houston, TX 77025-2420 |
Second Address | Houston, TX 77079-5309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 22/09/2009 |