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General NPI Number Information
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NPI Number | 1003181025
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Entity Type | Organization
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Legal Business Name | LAWTON K CHU DMD PC
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 2100 W NORTHWEST HWY SUITE 204
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City | GRAPEVINE
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State | TX
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Zip | 76051-7808
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Country | US
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Telephone | 817-329-6000
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Fax | 817-251-1833
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Provider Business Mailing Address
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Address Line | 2100 W NORTHWEST HWY SUITE 204
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City | GRAPEVINE
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State | TX
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Zip | 76051-7808
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Country | US
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Telephone | 817-329-6000
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Fax | 817-251-1833
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWTON CHU
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Credential | DMD
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Telephone | 817-329-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22151
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License Number State | TX
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