Healthcare Provider Details

I. General information

NPI: 1396590014
Provider Name (Legal Business Name): MAGGIE WU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 HANOVER ST
HANOVER MA
02339
US

IV. Provider business mailing address

345 E 24TH ST
NEW YORK NY
10010-4020
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-3900
  • Fax:
Mailing address:
  • Phone: 212-998-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN10000757
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: