Provider Demographics
NPI:1750272092
Name:RUAN, WANRONG (DMD)
Entity type:Individual
Prefix:
First Name:WANRONG
Middle Name:
Last Name:RUAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 S PARNELL AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3515
Mailing Address - Country:US
Mailing Address - Phone:312-714-6989
Mailing Address - Fax:
Practice Address - Street 1:647 N 1ST BANK DR
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8111
Practice Address - Country:US
Practice Address - Phone:847-358-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.036254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist