Provider Demographics
NPI:1407522121
Name:LUO, WENJING (DMD/PHD)
Entity Type:Individual
Prefix:DR
First Name:WENJING
Middle Name:
Last Name:LUO
Suffix:
Gender:F
Credentials:DMD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PATRIOT WAY
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6510
Mailing Address - Country:US
Mailing Address - Phone:682-554-1430
Mailing Address - Fax:
Practice Address - Street 1:1600 WOODBURY AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3250
Practice Address - Country:US
Practice Address - Phone:603-431-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice