Michael William Wong, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

019029087 Issued in IL

Practice address

3540 N Belt W
Suite E
Belleville, IL 62226-5975

Phone

(618) 233-8667

Fax

(618) 233-8715

NPI assigned

Mar 20, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395273600000",
    "number": "1902223548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 N BELT W",
            "address_2": "SUITE E",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265975",
            "telephone_number": "618-233-8667",
            "fax_number": "618-233-8715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 N BELT W",
            "address_2": "SUITE E",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265975",
            "telephone_number": "618-233-8667",
            "fax_number": "618-233-8715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-20",
        "last_updated": "2014-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019029087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Gerard Woehlke, LCPC
• Brittany Wolf, PA-C
• Oliver Wolfe, MD
• Woman to Woman, P.C.
• Women'S Healthcare Specialists, P.C.
• Max L Wood, LCSW
• Sarah Marie Woods
• Tim Woodstock, ATC
• Diana L Woolsey
• Brittany Wright, FNP-BC

• Pediatric Dentistry in Belleville, IL
• Providers in Belleville, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.