Healthcare Provider Details

I. General information

NPI: 1962798819
Provider Name (Legal Business Name): LILLIAN WU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W BROAD ST
PAULSBORO NJ
08066-1525
US

IV. Provider business mailing address

1133 COTTMAN AVE
PHILADELPHIA PA
19111-3647
US

V. Phone/Fax

Practice location:
  • Phone: 856-224-1700
  • Fax:
Mailing address:
  • Phone: 215-742-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS038855
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: