Provider Demographics
NPI:1477112621
Name:LU, LAWRENCE SONGYUAN (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:SONGYUAN
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 1:7710 ASPEN LODGE WAY APT 420
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4121
Mailing Address - Country:US
Mailing Address - Phone:731-819-6248
Mailing Address - Fax:
Practice Address - Street 1:1421 ARMOUR ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-2812
Practice Address - Country:US
Practice Address - Phone:423-458-6326
Practice Address - Fax:423-629-5278
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist