MEDICARE: HENRY C. LU DENTAL CORP DBA SUNNY SMILE DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D31313	CA
2	1223G0001X	General Practice Dentistry	D-31313	CA

General Provider Information

NPI Number	:	1750418224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY C. LU DENTAL CORP DBA SUNNY SMILE DENTAL

Provider Business Mailing Address
First Line	:	9216 LAS TUNAS DR.
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1907
Country	:	US
Telephone Number	:	626-287-1386
Fax Number	:

Provider Business Practice Location Address
First Line	:	9216 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1907
Country	:	US
Telephone Number	:	626-287-1386
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HENRY C LU
Credential	:	DDS
Telephone Number	:	626-287-1386

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/07/2008

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