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DR. SANDRA JEAN GONG DDS
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1104966241
Individual Registrant:DR. SANDRA JEAN GONG DDS
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
101 COMANCHE DR ARVIN, CA 93203-0172 US
Tel: 661-854-5558 Fax: 661-854-2696
Tel: 661-854-5558 Fax: 661-854-2696
Contact information for business:
PO BOX 172 ARVIN, CA 93203-0172 US
Tel: 661-854-5558 Fax: 661-854-2696
Tel: 661-854-5558 Fax: 661-854-2696
Registration Information:
NPI: 1104966241
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | CA | 29891 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
