Healthcare Provider Details

I. General information

NPI: 1831278290
Provider Name (Legal Business Name): JIANN-JANG WU BMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N LAKEMONT AVE SUITE 2400
WINTER PARK FL
32792-3208
US

IV. Provider business mailing address

201 N LAKEMONT AVE SUITE 2400
WINTER PARK FL
32792-3208
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-4773
  • Fax: 407-647-4548
Mailing address:
  • Phone: 407-647-4773
  • Fax: 407-647-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN0011535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: