Provider Demographics
NPI:1053796243
Name:ROSE L. WANG DMD PLLC
Entity type:Organization
Organization Name:ROSE L. WANG DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIPING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-882-7201
Mailing Address - Street 1:159 MAIN DUNSTABLE RD # RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3642
Mailing Address - Country:US
Mailing Address - Phone:603-882-7201
Mailing Address - Fax:603-882-9416
Practice Address - Street 1:159 MAIN DUNSTABLE RD # RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3642
Practice Address - Country:US
Practice Address - Phone:603-882-7201
Practice Address - Fax:603-882-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3059261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental