Provider Demographics
NPI:1033384573
Name:LU TANG DDS INC DBA LUCKY DENTAL
Entity Type:Organization
Organization Name:LU TANG DDS INC DBA LUCKY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LU
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-928-6000
Mailing Address - Street 1:2230 STORY RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1054
Mailing Address - Country:US
Mailing Address - Phone:408-928-6000
Mailing Address - Fax:408-928-6008
Practice Address - Street 1:2230 STORY RD
Practice Address - Street 2:SUITE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1054
Practice Address - Country:US
Practice Address - Phone:408-928-6000
Practice Address - Fax:408-928-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty