Henry K Pong, Dds, Psc | |
3820 Central Ave Lake Station IN 46405-2324 | |
(219) 962-8666 | |
Not Available |
Full Name | Henry K Pong, Dds, Psc |
---|---|
Speciality | Dentist |
Location | 3820 Central Ave, Lake Station, Indiana |
Authorized Official Name and Position | Henry K Pong (PRESIDENT) |
Authorized Official Contact | 2199628666 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Henry K Pong, Dds, Psc 3820 Central Ave Lake Station IN 46405-2324 Ph: (219) 962-8666 | Henry K Pong, Dds, Psc 3820 Central Ave Lake Station IN 46405-2324 Ph: (219) 962-8666 |
NPI Number | 1174620769 |
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Provider Enumeration Date | 09/17/2006 |
Last Update Date | 02/19/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174620769 | NPI | - | NPPES |
100167920A | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 54000645 (Indiana) | Primary |
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