Provider Demographics
NPI:1740544766
Name:WU, JOSE ANDRES (DENTIST)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANDRES
Last Name:WU
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 BIRCH FALLS LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:909-556-9805
Mailing Address - Fax:
Practice Address - Street 1:4407 WEST FUQUA STREET #R
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045
Practice Address - Country:US
Practice Address - Phone:713-434-7333
Practice Address - Fax:713-434-7336
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61379122300000X
TX281721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist