Provider Demographics
NPI:1578957536
Name:BEATRICE LU, DDS, INC
Entity Type:Organization
Organization Name:BEATRICE LU, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-679-0043
Mailing Address - Street 1:22 ODYSSEY STE 220
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3197
Mailing Address - Country:US
Mailing Address - Phone:949-679-0043
Mailing Address - Fax:949-679-1058
Practice Address - Street 1:22 ODYSSEY STE 220
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3197
Practice Address - Country:US
Practice Address - Phone:949-679-0043
Practice Address - Fax:949-679-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39178261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental