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NPI Code Detail

MEDICARE: EDA WU

MEDICARE: EDA WU
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
11223G0001XGeneral Practice Dentistry30.027710OH
21223G0001XGeneral Practice Dentistry133160509923UT
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1942942040
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDA WU
Provider Business Mailing Address
First Line : 17117 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44107-3622
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17117 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44107-3622
Country : US
Telephone Number : 216-221-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2022
Last Update Date : 04/18/2026

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Directions to “ EDA WU ” Practice Location

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