Provider Demographics
NPI:1053859645
Name:JIM LU, DDS PLLC
Entity Type:Organization
Organization Name:JIM LU, DDS PLLC
Other - Org Name:ASHEBORO FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-254-4191
Mailing Address - Street 1:350 N COX ST
Mailing Address - Street 2:SUITE #11
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5566
Mailing Address - Country:US
Mailing Address - Phone:336-629-6488
Mailing Address - Fax:
Practice Address - Street 1:350 N COX ST
Practice Address - Street 2:SUITE #11
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5566
Practice Address - Country:US
Practice Address - Phone:336-629-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty