Provider Demographics
NPI:1538503396
Name:MA, WENGE (DDS, PHD)
Entity Type:Individual
Prefix:
First Name:WENGE
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E CALAVERAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5412
Mailing Address - Country:US
Mailing Address - Phone:408-956-0188
Mailing Address - Fax:408-956-8682
Practice Address - Street 1:430 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5412
Practice Address - Country:US
Practice Address - Phone:408-956-0188
Practice Address - Fax:408-956-8682
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA561971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics