Healthcare Provider Details

I. General information

NPI: 1801939418
Provider Name (Legal Business Name): WAYNE KUO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5022 AIRPORT PULLING RD N UNIT #22
NAPLES FL
34105-2407
US

IV. Provider business mailing address

120 JACARANDA DR #207
PLANTATION FL
33324-2596
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-0598
  • Fax: 239-649-7147
Mailing address:
  • Phone: 702-354-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: