Provider Demographics
NPI:1164969747
Name:FU, LEI (DDS)
Entity Type:Individual
Prefix:
First Name:LEI
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 WALES DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5700
Mailing Address - Country:US
Mailing Address - Phone:504-284-8829
Mailing Address - Fax:
Practice Address - Street 1:3855 GLADE RD STE 150
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-4814
Practice Address - Country:US
Practice Address - Phone:406-800-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35791122300000X
CODEN.00203051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty