Provider Demographics
NPI:1235442591
Name:LU, MAI JONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAI
Middle Name:JONG
Last Name:LU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 COLUMNS CIR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6349
Mailing Address - Country:US
Mailing Address - Phone:678-362-5005
Mailing Address - Fax:
Practice Address - Street 1:9200 113TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6349
Practice Address - Country:US
Practice Address - Phone:678-362-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice