Active NPI
Wallace Wayne Wong, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Bellevue, WA
National Provider Identifier
1467574335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DE00008692
- Practice address
- 914 140TH Ave NE
Suite 102
Bellevue, WA 98005-3482 - Phone
- (425) 746-7126
- Fax
- (425) 401-8830
- NPI assigned
- Apr 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DE00008692 | WA | Primary |
Addresses
Primary practice location
914 140TH Ave NE
Suite 102
Bellevue, WA 98005-3482
Mailing address
914 140TH Avenue NE
Suite 102
Bellevue, WA 98005
Phone (425) 746-7126
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00008692 | WA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wallace W. Wong DDS | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Bellevue, WA
- NPI 1417300062
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265846400000",
"number": "1467574335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "914 140TH AVENUE NE",
"address_2": "SUITE 102",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "98005",
"telephone_number": "425-746-7126",
"fax_number": "425-401-8830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 140TH AVE NE",
"address_2": "SUITE 102",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980053482",
"telephone_number": "425-746-7126",
"fax_number": "425-401-8830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "WALLACE",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2010-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WA",
"license": "DE00008692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.