Individual
ROGER CHU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5337 W GRANDE MARKET DR, APPLETON, WI 54913-8442
(920) 731-7445
(920) 882-2946
Mailing address
5337 W GRANDE MARKET DR, APPLETON, WI 54913-8442
(920) 731-7445
(920) 882-2946
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS043239
PA
1223G0001X
General Practice Dentistry
Primary
6001128-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100220588
—
WI
Enumeration date
02/17/2022
Last updated
04/20/2023
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