Provider Demographics
NPI:1508393422
Name:LU, GANG ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GANG
Middle Name:ANTHONY
Last Name:LU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 EUCLID AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1626
Mailing Address - Country:US
Mailing Address - Phone:216-696-1441
Mailing Address - Fax:216-803-2222
Practice Address - Street 1:1110 EUCLID AVE STE 202
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115
Practice Address - Country:US
Practice Address - Phone:216-616-1155
Practice Address - Fax:216-803-2222
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300251031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice