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General NPI Number Information
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NPI Number | 1033384573
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Entity Type | Organization
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Legal Business Name | LU TANG DDS INC DBA LUCKY DENTAL
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 2230 STORY RD SUITE 20
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City | SAN JOSE
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State | CA
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Zip | 95122-1054
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Country | US
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Telephone | 408-928-6000
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Fax | 408-928-6008
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Provider Business Mailing Address
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Address Line | 2230 STORY RD SUITE 20
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City | SAN JOSE
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State | CA
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Zip | 95122-1054
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Country | US
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Telephone | 408-928-6000
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Fax | 408-928-6008
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Authorized Official
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Title or Position | PRESIDENT
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Name | LU TANG
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Credential | DDS
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Telephone | 408-928-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44100
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License Number State | CA
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