Provider Demographics
NPI:1720337538
Name:CHUANG, RITA (DDS)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:CHUANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SPRUCE ST APT 1010
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4571
Mailing Address - Country:US
Mailing Address - Phone:310-402-1699
Mailing Address - Fax:
Practice Address - Street 1:1520 SPRUCE ST APT 1010
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4571
Practice Address - Country:US
Practice Address - Phone:310-402-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0389651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics