Provider Demographics
NPI:1871931063
Name:WU, AGNES T (DDS)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:T
Last Name:WU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21830 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2517
Mailing Address - Country:US
Mailing Address - Phone:281-578-7100
Mailing Address - Fax:
Practice Address - Street 1:21830 KINGSLAND BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2517
Practice Address - Country:US
Practice Address - Phone:281-578-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist