Provider Demographics
NPI:1952719353
Name:LU, SHANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 N TALBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-4143
Mailing Address - Country:US
Mailing Address - Phone:336-248-6790
Mailing Address - Fax:336-248-6790
Practice Address - Street 1:242 N TALBERT BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292
Practice Address - Country:US
Practice Address - Phone:336-248-6790
Practice Address - Fax:336-248-6790
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150987390200000X
NC9969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program