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General NPI Number Information
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NPI Number | 1891104006
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Entity Type | Individual
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Provider Name | RONGNING(GRACE) WU
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Gender | Female
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 2124 CORNELL ROAD DEPARTMENT OF ORTHODONTICS
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City | CLEVELAND
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State | OH
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Zip | 44106-4905
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Country | US
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Telephone | 216-368-0262
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Fax |
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Provider Business Mailing Address
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Address Line | 236 CROCKER PARK BLVD APT 204
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City | CLEVELAND
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State | OH
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Zip | 44145-8144
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Country | US
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Telephone | 510-283-4422
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.024284
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License Number State | OH
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