Healthcare Provider Details

I. General information

NPI: 1942947635
Provider Name (Legal Business Name): WEN ZHOU DMD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9769 VALLEY VIEW RD
MACEDONIA OH
44056-2038
US

IV. Provider business mailing address

1309 FIELDSTONE CT
BROADVIEW HTS OH
44147-3624
US

V. Phone/Fax

Practice location:
  • Phone: 330-468-6670
  • Fax: 330-468-5915
Mailing address:
  • Phone: 305-878-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.026830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: