MEDICARE: LAWRENCE WU PROFESSIONAL DENTAL CORP.

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
1	1223G0001X	General Practice Dentistry	51158	CA

General Provider Information

NPI Number	:	1831586197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE WU PROFESSIONAL DENTAL CORP.

Provider Business Mailing Address
First Line	:	1319 BLOSSOM HILL RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-3801
Country	:	US
Telephone Number	:	408-266-2800
Fax Number	:	408-266-5050

Provider Business Practice Location Address
First Line	:	1319 BLOSSOM HILL RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-3801
Country	:	US
Telephone Number	:	408-266-2800
Fax Number	:	408-266-5050

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE WU
Credential	:	DDS
Telephone Number	:	408-266-2800

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	04/23/2015

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