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General NPI Number Information
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NPI Number | 1346728664
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Entity Type | Organization
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Legal Business Name | JIM LU AND SHANE LU DDS PLLC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 2430 S CHURCH ST STE B
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City | BURLINGTON
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State | NC
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Zip | 27215
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Country | US
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Telephone | 336-639-7101
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Fax |
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Provider Business Mailing Address
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Address Line | 322 S DAVIE ST APT 208
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City | GREENSBORO
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State | NC
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Zip | 27401-2856
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Country | US
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Telephone | 706-254-4191
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIM LU
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Credential | DDS
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Telephone | 706-254-4191
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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 | 9969
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10319
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License Number State | NC
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