Provider Demographics
NPI:1093853574
Name:RONG, WENQIANG (DDS)
Entity Type:Individual
Prefix:
First Name:WENQIANG
Middle Name:
Last Name:RONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 BERRYESSA RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2907
Mailing Address - Country:US
Mailing Address - Phone:408-258-6669
Mailing Address - Fax:408-258-3666
Practice Address - Street 1:2664 BERRYESSA RD STE 205
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2907
Practice Address - Country:US
Practice Address - Phone:408-258-6669
Practice Address - Fax:408-258-3666
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice