Basic Information
| Provider Information | |||||||||
| NPI: | 1740544766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WU | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ANDRES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DENTIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5218 BIRCH FALLS LN | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095569805 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4407 WEST FUQUA STREET #R | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134347333 | ||||||||
| FaxNumber: | 7134347336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 61379 | CA | N | Dental Providers | Dentist | 1223G0001X | 28172 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.