Healthcare Provider Details

I. General information

NPI: 1871632174
Provider Name (Legal Business Name): TOWER DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336A TREMONT ST
BOSTON MA
02116-5605
US

IV. Provider business mailing address

336A TREMONT ST
BOSTON MA
02116-5605
US

V. Phone/Fax

Practice location:
  • Phone: 617-482-2476
  • Fax:
Mailing address:
  • Phone: 617-482-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17629
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number17818
License Number StateMA

VIII. Authorized Official

Name: DR. RONGJANG WU
Title or Position: OWNER
Credential: DMD
Phone: 617-482-2476