Provider Demographics
NPI:1245487313
Name:LU, CHARLES C (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:LU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:837 58TH ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3662
Mailing Address - Country:US
Mailing Address - Phone:718-686-9888
Mailing Address - Fax:718-626-9889
Practice Address - Street 1:837 58TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3662
Practice Address - Country:US
Practice Address - Phone:718-686-9888
Practice Address - Fax:718-626-9889
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY054716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist