NPIMap

Organization Active NPI

Walter S. Hong, D.D.S., P.a.

Doing business as Lake Shore Family Dental

  • Dental Clinic/Center
  • Pasadena, MD
National Provider Identifier
1063558617
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
13307 Issued in MD
Legal business name
WALTER S. HONG, D.D.S., P.A.
Doing business as
Lake Shore Family Dental
Practice address
4330 Mountain Rd
Pasadena, MD 21122-4520
Phone
(410) 255-8001
Fax
(410) 255-0687
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Walter S Hong, D.D.S.NPI 1083617922
Title
President
Phone
(410) 255-8001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 13307 MD Primary

Addresses

Primary practice location

4330 Mountain Rd
Pasadena, MD 21122-4520

Mailing address

4330 Mountain Rd
Pasadena, MD 21122-4520
Phone (410) 255-8001

Other names 1

  • Lake Shore Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

4330 Mountain Rd
Pasadena, MD 21122
Phone (410) 255-8001

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063558617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4330 MOUNTAIN RD",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211224520",
            "telephone_number": "410-255-8001",
            "fax_number": "410-255-0687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 MOUNTAIN RD",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211224520",
            "telephone_number": "410-255-8001",
            "fax_number": "410-255-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER S. HONG, D.D.S., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HONG",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-255-8001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MD",
            "license": "13307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Shore Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.