Individual provider Active NPI

Allen Wong, DDS

  • General Practice Dentistry
  • Hermitage, TN
National Provider Identifier
1487609749
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12451 Issued in TN
Practice address
3901 Central Pike Ste 500
Hermitage, TN 37076-3431
Phone
(615) 933-7300
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 36854 CA
General Practice Dentistry 1223G0001X 12451 TN Primary

Addresses

Primary practice location

3901 Central Pike Ste 500
Hermitage, TN 37076-3431

Mailing address

3901 Central Pike Ste 500
Hermitage, TN 37076-3431
Phone (615) 933-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240731002017 TN Practitioner - Dentist 0941576813 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36854CAMDNutrition Education Nutritionist

Practice roles

OrganizationSpecialtyStatusNew patients
Kdnashvilledc General Practice CurrentSince Jul 15, 2024 Accepting new patients

Locations

9200 Shelbyville Rd
Ste 531
Louisville, KY 40222

3901 Central Pike
Ste 500
Hermitage, TN 37076
Phone (502) 792-0236

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.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1487609749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 CENTRAL PIKE STE 500",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370763431",
            "telephone_number": "615-933-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CENTRAL PIKE STE 500",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370763431",
            "telephone_number": "615-933-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "ALLEN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36854",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "12451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermitage, TN

Sources for this page

Verify at the official NPI Registry.