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General NPI Number Information
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NPI Number | 1063757623
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Entity Type | Individual
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Provider Name | DI WU DDS
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Gender | Female
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 6655 TRAVIS ST #460, PEDIATRIC DENTISTRY
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City | HOUSTON
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State | TX
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Zip | 77030-1312
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Country | US
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Telephone | 734-945-0451
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Fax |
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Provider Business Mailing Address
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Address Line | 6655 TRAVIS ST #460, PEDIATRIC DENTISTRY
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City | HOUSTON
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State | TX
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Zip | 77030-1312
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Country | US
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Telephone | 734-945-0451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901020851
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 2901020851
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30384
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License Number State | TX
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