MEDICARE: DR. LESTER WOO D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	058220	NY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DE61103402	WA

General Provider Information

NPI Number	:	1902124274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESTER WOO D.D.S.

Provider Business Mailing Address
First Line	:	5605 LAKEWOOD TOWNE CENTER BLVD SW STE B
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3855
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5605 LAKEWOOD TOWNE CENTER BLVD SW STE B
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3855
Country	:	US
Telephone Number	:	253-200-4049
Fax Number	:

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

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	07/07/2021

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