=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366918476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAM S. CHU, D.D.S., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2018
-----------------------------------------------------
Last Update Date | 10/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 N BRIDGE ST
-----------------------------------------------------
City | JONESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28642-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-835-7500
-----------------------------------------------------
Fax | 336-835-6809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 129 N BRIDGE ST
-----------------------------------------------------
City | JONESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28642-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-835-7500
-----------------------------------------------------
Fax | 336-835-6809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | LAM SUE CHU
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 336-835-7500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------