Healthcare Provider Details

I. General information

NPI: 1871756775
Provider Name (Legal Business Name): EVERETT WU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E TURKEYFOOT LAKE RD
AKRON OH
44312-5365
US

IV. Provider business mailing address

1600 E TURKEYFOOT LAKE RD
AKRON OH
44312-5365
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-3198
  • Fax: 330-253-9812
Mailing address:
  • Phone: 330-253-3198
  • Fax: 330-253-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30022836
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: