Healthcare Provider Details

I. General information

NPI: 1356895593
Provider Name (Legal Business Name): WENDY ZHU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MILLER PARK WAY
WEST MILWAUKEE WI
53219-1641
US

IV. Provider business mailing address

2100 MILLER PARK WAY
WEST MILWAUKEE WI
53219-1641
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-4540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00203727
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1001405-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: