Provider Demographics
NPI:1144602608
Name:WU, ERICA (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13302 PRESIDIO PL
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8607
Mailing Address - Country:US
Mailing Address - Phone:714-616-4800
Mailing Address - Fax:
Practice Address - Street 1:1205 RENAISSANCE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-2418
Practice Address - Country:US
Practice Address - Phone:714-616-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021605122300000X
CA103714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist