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NPI Code Detail

MEDICARE: JONATHAN THOMAS WU DMD

MEDICARE:   JONATHAN THOMAS WU  DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN015689GA

General Provider Information

NPI Number : 1033603212
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN THOMAS WU DMD
Provider Business Mailing Address
First Line : 582 AUTUMN SHORE DR
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-7427
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3330 PIEDMONT RD NE STE 13
Second Line :
City : ATLANTA
State : GA
Zip : 30305-1726
Country : US
Telephone Number : 404-237-5330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2018
Last Update Date : 06/20/2018

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Directions to “ JONATHAN THOMAS WU DMD” Practice Location

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