Provider Demographics
NPI:1790901551
Name:LU, JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
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 1:133 FRANKLIN CORNER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-896-0700
Mailing Address - Fax:856-546-2993
Practice Address - Street 1:133 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-896-0700
Practice Address - Fax:856-546-2993
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0183441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics