Provider Demographics
NPI:1598115883
Name:WU, STEPHANIE CHERI (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CHERI
Last Name:WU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 CRIANZA PL APT 355
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-4061
Mailing Address - Country:US
Mailing Address - Phone:201-956-8762
Mailing Address - Fax:
Practice Address - Street 1:1313 DOLLEY MADISON BLVD STE 307
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101
Practice Address - Country:US
Practice Address - Phone:703-847-0989
Practice Address - Fax:703-847-2681
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014159471223E0200X
MADN18573391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223E0200XDental ProvidersDentistEndodontics