Provider Demographics
NPI:1467342188
Name:RONG, SIQIANG (DMD)
Entity type:Individual
Prefix:
First Name:SIQIANG
Middle Name:
Last Name:RONG
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 1:1727 E PECOS RD APT 3026
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1872
Mailing Address - Country:US
Mailing Address - Phone:602-815-3177
Mailing Address - Fax:
Practice Address - Street 1:1714 W HUNT HWY STE 100
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143-5245
Practice Address - Country:US
Practice Address - Phone:480-882-3119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0125141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice