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General NPI Number Information
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NPI Number | 1447822671
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Entity Type | Individual
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Provider Name | COCO JEONG EN ROENING DDS
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Gender | Female
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 635 ALBANY ST
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City | BOSTON
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State | MA
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Zip | 02118-3550
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Country | US
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Telephone | 617-358-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 725 HARRISON AVE UNIT E402
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City | BOSTON
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State | MA
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Zip | 02118-2758
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Country | US
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Telephone | 415-542-6632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | DL100814
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License Number State | MA
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