Healthcare Provider Details

I. General information

NPI: 1952650095
Provider Name (Legal Business Name): PING SEUNG ALICE WU D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8729 CAMDEN PARK DR
RALEIGH NC
27613
US

IV. Provider business mailing address

615 VILLA GRANDE DR
WINTERVILLE NC
28590-8072
US

V. Phone/Fax

Practice location:
  • Phone: 919-360-0072
  • Fax:
Mailing address:
  • Phone: 919-360-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9281
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: