Individual
AIS WU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1647 ADMIRAL TAUSSIG BLVD, NORFOLK, VA 23511-2803
(914) 595-6863
Mailing address
1647 ADMIRAL TAUSSIG BLVD, NORFOLK, VA 23511-2803
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13257
CT
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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