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General NPI Number Information
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NPI Number | 1235620733
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Entity Type | Organization
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Legal Business Name | GANG ANTHONY LU, D.M.D., INC
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 1110 EUCLID AVE STE 202
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City | CLEVELAND
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State | OH
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Zip | 44115
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Country | US
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Telephone | 216-616-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 EUCLID AVE STE 202
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City | CLEVELAND
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State | OH
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Zip | 44115-1626
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Country | US
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Telephone | 216-616-1155
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GANG ANTHONY LU
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Credential | DMD
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Telephone | 216-616-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 30.025103
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License Number State | OH
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