MEDICARE: TINGTING WU D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-024311	OH

General Provider Information

NPI Number	:	1649617200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINGTING WU D.M.D

Provider Business Mailing Address
First Line	:	8086 E BROAD ST
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-8024
Country	:	US
Telephone Number	:	217-540-5100
Fax Number	:	877-635-3298

Provider Business Practice Location Address
First Line	:	8086 E BROAD ST
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-8024
Country	:	US
Telephone Number	:	217-540-5100
Fax Number	:	877-635-3298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	02/10/2015

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