Provider Demographics
NPI:1417095993
Name:HENRY LU DENTAL CORP.
Entity Type:Organization
Organization Name:HENRY LU DENTAL CORP.
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-281-3651
Mailing Address - Street 1:801 W. VALLEY BLVD.
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803
Mailing Address - Country:US
Mailing Address - Phone:626-281-3651
Mailing Address - Fax:
Practice Address - Street 1:801 W VALLEY BLVD
Practice Address - Street 2:SUITE # 201
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3250
Practice Address - Country:US
Practice Address - Phone:626-281-3651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD313131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty