Provider Demographics
NPI:1750418224
Name:HENRY C. LU DENTAL CORP DBA SUNNY SMILE DENTAL
Entity type:Organization
Organization Name:HENRY C. LU DENTAL CORP DBA SUNNY SMILE DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-287-1386
Mailing Address - Street 1:9216 LAS TUNAS DR.
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1907
Mailing Address - Country:US
Mailing Address - Phone:626-287-1386
Mailing Address - Fax:
Practice Address - Street 1:9216 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1907
Practice Address - Country:US
Practice Address - Phone:626-287-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY LU DENTAL CORP DBA SUNNY SMILE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD313131223G0001X
CAD-313131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty