Provider Demographics
NPI:1093724817
Name:JOANNE DENTAL LLC
Entity Type:Organization
Organization Name:JOANNE DENTAL LLC
Other - Org Name:JOANNE LU DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-768-1011
Mailing Address - Street 1:13300 - 46 S. CLEVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3883
Mailing Address - Country:US
Mailing Address - Phone:239-768-1011
Mailing Address - Fax:239-768-9311
Practice Address - Street 1:13300 - 46 S. CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3883
Practice Address - Country:US
Practice Address - Phone:239-768-1011
Practice Address - Fax:239-768-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty