Provider Demographics
NPI:1629423819
Name:WU DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:WU DENTAL CENTER PLLC
Other - Org Name:DR WU DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-409-7168
Mailing Address - Street 1:5205 S MASON RD
Mailing Address - Street 2:STE 160
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7138
Mailing Address - Country:US
Mailing Address - Phone:832-409-7168
Mailing Address - Fax:832-777-7056
Practice Address - Street 1:5511 BARON RIDGE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6613
Practice Address - Country:US
Practice Address - Phone:210-332-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270771223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty