Provider Demographics
NPI:1912272170
Name:ROSE L. WANG, DMD, LLC
Entity type:Organization
Organization Name:ROSE L. WANG, DMD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-820-9730
Mailing Address - Street 1:394 LOWELL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2545
Mailing Address - Country:US
Mailing Address - Phone:781-862-3333
Mailing Address - Fax:
Practice Address - Street 1:394 LOWELL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2545
Practice Address - Country:US
Practice Address - Phone:781-862-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN190051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty