Provider Demographics
NPI:1790779304
Name:ANDERSON, PEYCHI WU (DMD)
Entity Type:Individual
Prefix:DR
First Name:PEYCHI
Middle Name:WU
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PEYCHI
Other - Middle Name:PATRICIA
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:10798 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3646
Mailing Address - Country:US
Mailing Address - Phone:410-992-4400
Mailing Address - Fax:
Practice Address - Street 1:10003 NW MILITARY HWY STE 3201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1892
Practice Address - Country:US
Practice Address - Phone:210-417-4181
Practice Address - Fax:210-504-4969
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262031223P0221X
MD161951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2815656Medicaid