Provider Demographics
NPI:1073681326
Name:WANG, ROSE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:L
Last Name:WANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MAIN DUNSTABLE 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
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice