Provider Demographics
NPI:1316193972
Name:LU, MIKE WEITING (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:WEITING
Last Name:LU
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 1:289 LONG VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1300
Mailing Address - Country:US
Mailing Address - Phone:408-858-8921
Mailing Address - Fax:
Practice Address - Street 1:171 CURTNER AVE STE 80
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-1059
Practice Address - Country:US
Practice Address - Phone:408-572-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice