Provider Demographics
NPI:1518021104
Name:WU, RONG-JANG (DMD)
Entity Type:Individual
Prefix:
First Name:RONG-JANG
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336A TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5605
Mailing Address - Country:US
Mailing Address - Phone:617-482-2476
Mailing Address - Fax:617-482-2476
Practice Address - Street 1:336A TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5605
Practice Address - Country:US
Practice Address - Phone:617-482-2476
Practice Address - Fax:617-482-2476
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178181223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics