Provider Demographics
NPI:1457700171
Name:FENG, RUOXUE (DMD)
Entity Type:Individual
Prefix:
First Name:RUOXUE
Middle Name:
Last Name:FENG
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:TRIDENT GROUP
Mailing Address - Street 2:16901 MELFORD BLVD #332
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715
Mailing Address - Country:US
Mailing Address - Phone:301-358-5461
Mailing Address - Fax:301-358-5552
Practice Address - Street 1:8077 FLORENCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3894
Practice Address - Country:US
Practice Address - Phone:562-381-2442
Practice Address - Fax:717-848-0812
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS405531223E0200X
CADDS1061561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics