Provider Demographics
NPI:1649323007
Name:LU, JIANWEI JENNY (D DS)
Entity type:Individual
Prefix:DR
First Name:JIANWEI
Middle Name:JENNY
Last Name:LU
Suffix:
Gender:F
Credentials:D DS
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1282 NW CIVIC DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5509
Mailing Address - Country:US
Mailing Address - Phone:503-760-1334
Mailing Address - Fax:503-762-1955
Practice Address - Street 1:1282 NW CIVIC DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5509
Practice Address - Country:US
Practice Address - Phone:503-760-1334
Practice Address - Fax:503-762-1955
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR77391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice